Common insurance terms to know
Common insurance terms to know
• Premium – The money you pay every month for your plan.
• Deductible – The amount you pay for care before your plan starts helping.
• Copay( Copayment) – A set fee you pay for a doctor visit or medicine.
• Coinsurance – The percentage of a cost you pay after meeting your deductible.
• Out-of-Pocket Maximum – The most you’ ll pay in a year for covered services. After this, the plan pays 100 %.
• Formulary – The list of medicines your plan covers.
• Prior Authorization – Approval from your plan before you can get certain services or medicines.
• Network / In-Network – Doctors, hospitals, and pharmacies that work with your plan.
• Out-of-Network – Providers that don’ t work with your plan. Using them usually costs more.
• Annual Notice of Change( ANOC) – A letter that tells you about changes to your plan for next year.
• Appeal – A request to have the plan review a decision you disagree with.
• Grievance – A complaint about your care or plan service.
• Step Therapy – A rule that asks you to try a cheaper medicine before a more expensive one.
• Coverage Determination – A decision from your plan about whether a service or medicine is covered.
• Benefit Period – The time Medicare uses to count hospital or nursing care costs.
• Explanation of Benefits( EOB) – A paper or online statement that shows what the plan paid and what you may owe. An EOB is NOT a bill.
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