Glossary

Balance Billing

When providers bill patients the difference between the cost of a service and the amount paid by the insurance company.
Benefit

A service/supply covered by the health plan.
Coinsurance

The percentage of health care expenses the patient pays after paying the deductible.
Deductible

The amount the patient pays for covered services before the insurance company begins to pay.
Drug Tiers

Groups of different drugs, usually grouped by price.
Emergency

A serious illness or injury requiring immediate medical care.
Formulary

A list of prescription drugs covered by the health plan.
Network

Providers/facilities/suppliers who are contracted with the health plan.
Network Provider

Provider who has a contract with the health plan to provide services at a discount.
Out-of-Pocket Maximum

The limit on costs the insured pays for covered services, usually based on a calendar year.
Premium

The amount paid to the health plan for health coverage, usually paid monthly.
Primary Care Physician (PCP)

A doctor who is part of the health plans' network; the patient's main contact for care; provides referrals to specialists if needed.
Providers

Licensed doctors, hospitals, ambulatory surgical centers, testing facilities, etc. who provide health care services to patients.
Referral

A form the PCP gives to a patient so they can get treatment from a specialist.
Urgent Care Centers

Facilities that provide care for urgent but non-life-threatening medical issues.