Common Insurance Terms

5. Primary Care Provider who is responsible for monitoring an individuals overall healthcare needs.
6. The person responsible for the insurance premiums, or whose employment is the basis for eligibility for membership in an insurance plan.
8. The maximum length of time for which a member is eligible for benefits.
10. The person who is responsible for any account balances.
11. The coverage that pays after the primary and secondary.
12. Approval needed for care beyond what is provided by the PCP. This most commonly required when seeing a specialist.
13. The set or fixed dollar amount the patient is required to pay each time a particular medical service is rendered.
14. The money the insurance company pays a healthcare provider for medical services if you become ill or injured.

1. Permission from the insurance company that they will pay for a given procedure.
2. The patient and the insurance company share the cost of medical procedures in a specified proportion. For example: 80% (company) and 20% (patient).
3. The coverage which pays healthcare expenses first.
4. Your spouse and children.
7. The coverage which provides payment for expenses not covered by the primary.
9. The cumulative amount that the patient must pay annually before benefits will be paid by the insurance company.
13. Insurance purchased by an insured when they lose their job or their employer sponsored coverage is otherwise terminated.