Health Insurance Terms

Question 1

Claim

Answer 1

A formal request for payment usually sent by the doctor/hospital to your insurance company

Question 2

EOB

Answer 2

Explanation of Benefits. Sent by the insurance company to the medical provider along with payment, explaining how much they paid and why.

Question 3

Co-payment

Answer 3

A fixed dollar amount you pay for a particular medical service (like a doctor’s visit), regardless of the total amount due

Question 4

Co-insurance

Answer 4

A percentage of the total amount due for a medical service that you will pay (typically 10% or 20%)

Question 5

Out-of-pocket Maximum

Answer 5

The maximum amount of money you will have to pay in a calendar year for all medical services, after which your insurance will pay 100%

Question 6

Premium

Answer 6

The cost of your insurance policy - usually paid monthly (or with each paycheck, if insurance is through your employer)

Question 7

Deductible

Answer 7

The amount of money you will have to pay for all medical services BEFORE your insurance will pay anything. Resets every year.