Understanding your health insurance benefits is an important part of managing your healthcare costs. However, terms like deductible, copay, and coinsurance, along with knowing which services are covered and when, can be confusing.
To help make health insurance easier to understand, we've provided explanations of common insurance terms and concepts. Learning the basics can help you better understand your coverage, estimate costs, and make informed decisions about your care.
We’ve put together the following list of common health insurance terms and conditions.
This term is often referred to as COB and refers to when two insurance plans work together to pay claims for the same person. You need to provide COB to your insurance company to determine which plan has the primary responsibility.
This term is often referred to as an EOB. This is a statement from your insurance provider explaining how and why a claim for medical services was or was not paid.
This is Information that the healthcare organization submits to your insurance provider to be reimbursed for the services you were provided. The insurance provider uses the claim to process payments toward your care.
If you have more than one insurance plan, please let us know because then there will be Coordination of Benefits (COB). After your primary insurance pays its portion, we’ll send a claim for the remaining balance to your secondary insurance provider. If any amount is leftover, that’s what you pay.
Out-of-pocket expenses refer to the costs not covered by your insurance. The expenses are what you pay for your healthcare and vary in amount, depending on your insurance plan’s benefits.
Based on your plan, you’ll have an annual maximum out-of-pocket amount you pay. After you reach the maximum, your insurance usually covers everything at 100% for the rest of the year.
Your out-of-pocket expenses can include:
