Insurance Terminology

5. The date your coverage begins or the date a change in your coverage takes effect.
6. The maximum amount a health plan will reimburse a doctor or hospital for a given service.
8. The percentage of the costs of a covered health care service or prescription drug you pay after you've paid your deductible.
10. The amount you pay for most covered services before your health plan starts to pay.
11. An itemized bill from a health care provider for health services provided to a member. Each claim is identified by a Document Control Number (DCN).
12. The most you have to pay for covered services in a plan year.

1. Services Services provided when a member is registered as a bed patient and is treated as such in a health care facility, such as a hospital.
2. Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other facility.
3. The process to get approval from your health plan before undergoing care. Also called prior authorization.
4. A health care professional whose practice is limited to a certain branch of medicine.
7. The set dollar amount you pay for a covered health care service at the time you receive care.
9. The group of doctors, hospitals, and other health care professionals that contracts with a health plan to deliver medical services to its members. In-network (INN) providers are typically covered by the plan, but out-of-network (OON) providers are partially covered or not covered by the plan.