A health insurance claim is like sending a bill to your insurance company. When you get medical care, either you or your doctor lets your insurer know, so they can help pay their share of the costs.

Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100 percent. For example, if your coinsurance is 20 percent, you pay 20 percent of the cost of your covered medical bills. Your health insurance will pay the other 80 percent.

A health insurance copay (or copayment) is a flat fee you pay for a medical service or prescription, with your insurance covering the rest. You typically pay it at your appointment or when you pick up a prescription.

Covered services in a health plan are the medical treatments or procedures that your insurance agrees to pay for, either fully or partially.

The deductible is the set amount you pay for covered health care services before your insurance plan starts to chip in. For example, if you have a $500 deductible, you cover the first $500 of your medical bills (for covered services), and then your insurance will start to cover their agreed-upon portion.

This plan has an embedded deductible policy. This means there is an individual deductible for each person and a family deductible.
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If an individual deductible is $500, that person only has to meet that amount before the insurance starts covering their expenses at a co-insurance.

Once the combined medical expenses of all family members meet this family deductible, of $1,500, the insurance begins to pay for everyone, even if some members haven't reached their individual deductibles.
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An Exclusive Provider Organization (EPO) health plan offers a network of doctors you can see without referrals but it usually doesn’t cover care outside of its network unless it’s an emergency.

An exclusion is a condition or service that is not covered by your insurance plan. Just as each plan has a list of items that the insurance company will cover, they also have a list of items they will not.

A Health Savings Account (HSA), is a special tax-free savings account just for medical expenses. It allows you to put money away and withdraw it tax free, as long as you use it for qualified medical expenses, like deductibles, copayments, coinsurance, and more. If you don’t spend it all, no worries - it rolls over to the next year! Just remember, to have an HSA, you typically need a High Deductible Health Plan.

A High Deductible Health Plan (HDHP), also commonly known as an HSA eligible plan, is a type of health insurance that has a higher upfront deductible. This means you pay more out-of-pocket before insurance kicks in but the upside is that it usually has lower monthly premiums, and it lets you use a tax-free Health Savings Account (HSA) to help cover those initial costs.

A HMO (Health Maintenance Organization) health plan focuses on keeping costs low. You choose a primary doctor who coordinates your care and you’ll usually need their referral to see specialists. It typically doesn’t cover care outside its network unless it’s an emergency.

In-network refers to doctors or facilities that have special agreements with your health insurance. Seeing them usually means lower costs for you as they’re part of your insurance’s preferred list.

Out-of-network means a doctor or facility isn’t on your health insurance’s preferred list. If you get care there, it might cost you more, or sometimes, your insurance won’t cover it at all, except in emergencies.

Out-of-pocket costs are what you personally pay for medical services. They include deductibles, coinsurance, and copayments. These costs aren't reimbursed by your insurance. You can think of it as the amount you cover, while the rest is paid by your insurance.

An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year. Once you hit this limit, your insurance typically covers the rest 100% for the rest of the plan year.

A Point of Service (POS) plan, is a type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. You usually need a referral from your primary doctor to see a specialist, but you also have the flexibility to see out-of-network doctors, though it might cost a bit more.

A Preferred Provider Organization (PPO) health plan gives you flexibility. You can see any doctor without a referral, and while covered services from its network of selected health care providers are cheaper, the plan still offers some coverage if you go outside of the network.

Your premium is like a subscription fee for your coverage. It’s the amount you pay for your health insurance every month. It doesn’t apply towards your deductible or out-of-pocket max. When the health insurance is provided by your employer, it’s commonly deducted per pay period from your check.