Insurance Terminology

4. This is a document we send providers once the claim has been processed with payment information
5. A fixed amount you pay prior to having a covered health care service
7. The amount you pay for covered services before your insurance plan starts to pay
9. A type of medical plan in which coverage is provided to participants through a network of selected health care providers, such as hospitals and physicians
11. Maximum amount a plan will pay for a covered service
12. The percentage you will pay of the allowed amount once your deductible is met
13. providers or health care facilities that are part of a health plan's network

1. A type of health insurance plan that usually limits coverage to care from doctors who work for or contracted with the plan. It generally won’t cover out-of-network care except for a true emergency
2. The most you will pay during a policy period before your plan begins to pay 100% of the allowed amount
3. This is a document we send members to let them know how a claim was processed. (NOT A BILL)
6. A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary
8. When a provider bills you for the difference between the provider’s charge and the allowed amount
10. Doctor or facility that does not have a contract with your health insurance plan provider