Llorens Insurance Agency, Inc.

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

Copay – a set dollar amount the insured pays for services

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


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