Commonly Used Healthcare Terms
Co-Insurance: The amount of a medical bill you are responsible for after your deductible has been met. This is a set percentage and listed on your insurance benefits form or your health insurance card. For example, “80/20” means after you have paid your deductible, the insurance will pay 80% of the medical claim and you are responsible for the remaining 20%.
Co-Pay: A fixed amount of money that must be paid by you for doctor’s visits and prescriptions. Your insurer will pay the rest.
Deductible: A specified amount of money that you must pay “out-of-pocket” before your insurance plan begins paying.
Inpatient Care: A procedure or service performed at a hospital that requires an overnight stay.
Limitations & Exclusions: Health-related procedures and items that your health insurance provider will not pay for.
Non-Prescription Medication: Also referred to as “over-the-counter,” this medication does not require a physician note and can be purchased with cash or credit at any pharmacy or grocery store. These medications are usually paid for by insurance plans.
Outpatient: A procedure or service at a hospital or clinic that does not require an overnight hospital stay.
Pre-existing condition: A physical condition or illness you had before you enrolled in this health insurance plan. Many U.S. health insurance providers will not cover expenses related to illnesses you had before your enrollment.
Preferred Care Provider / In-Network Provider: A physician who is on your health insurance provider’s list of physicians to visit. If you visit this provider, your out-of-pocket costs are usually lower.
Premium: The (monthly) payment required to buy the health insurance plan and keep it in force.
Prescription Medication: Medication that requires a signed note from your physician to purchase at a pharmacy.
Primary Care Physician: A general physician you have established routine care with.
Referral: When a doctor suggests that you visit another more specialized doctor for further health attention related to a specific health problem.
For more information about your health insurance benefits or to find a local physician (who will accept your health insurance), please consult the website of your health insurance plan.