The amount that is paid by an employee, their employer, or both to receive coverage from a health insurance plan. A covered employee's share of the premium is generally paid periodically, such as monthly, and deducted from their paycheck. The premium does not count toward the plan’s deductible or out-of-pocket maximum.

A fixed dollar amount that the covered employee must pay out of pocket each plan year before the plan will begin covering non-preventive health expenses. Plans usually require separate limits per person and per family.

A percentage of a health care cost that the covered employee pays after meeting the deductible; the plan will cover the remaining cost.

A fixed dollar amount that the covered employee pays for medical services. Any additional cost will be covered by the plan.

A list of prescription drugs covered by the health plan. The list is structured in tiers that subsidize low-cost generics at a higher percentage than more expensive brand-name or specialty drugs.

A type of health insurance plan that only covers services you receive from doctors and facilities within the plan’s network. You will need to select a Primary Care Physician (PCP) who will coordinate your care. If you need to see a specialist, your PCP must provide a referral or the HMO will not pay for the service. There is no out-of-network coverage except for emergency services.

HSAs may be opened by employees who enroll in an eligible high deductible health plan. Employees can put money in an HSA using pre-tax dollars up to an annual limit set by the government. HSA funds may be used to pay for medical expenses tax-free whether or not the deductible has been met. HSAs are individually owned and the account remains with an employee after employment ends.

HDHPs have very low premiums in exchange for higher deductibles. Only preventive care is covered before the deductible is met. HDHPs are intended for users with minimal medical needs. Most HDHPs are eligible for HSAs so enrollees can set aside money specifically for medical expenses.

Doctors, facilities, and other providers with whom the health plan has an agreement to deliver care to its members, usually at a discounted rate. Health plans cover a greater share of the cost for in-network health providers than for providers who are out of network.

Service providers that have not negotiated a rate with a health plan. The plan may have separate deductibles, cost sharing, and limits for out-of-network care. If a plan does not provide out-of-network coverage, the employee will pay the full cost of service out of pocket.

The most an employee could pay out of pocket during a plan year for their share of the costs of covered services. Once the maximum is reached, the health plan will cover services at 100%.

A type of health insurance plan that offers in-network and out-of-network coverage for medical services. Premiums tend to be higher with PPO plans, but there is generally a large network of providers to choose from.