Coinsurance
Your share of costs after meeting your deductible. For example, you pay 20% and insurance pays 80%.
Benefits, translated
Understand the language before you make the decision.
Search 43 common insurance and enrollment terms explained in plain English.
43 terms
General Insurance
8 definitions
Copay (Co-payment)
A fixed amount you pay for a covered service, such as $25 for a doctor visit.
Deductible
The amount you pay out-of-pocket before your insurance starts paying for covered services.
Explanation of Benefits (EOB)
A statement from your insurer showing what was covered and what you may owe for a claim.
In-Network
Doctors and facilities that have agreements with your plan to provide services at negotiated rates.
Out-of-Network
Providers without agreements with your plan. Using them typically costs more.
Out-of-Pocket Maximum
The most you will pay for covered services in a plan year. After reaching it, the plan generally pays 100% of covered services.
Premium
The amount paid—usually each month—to maintain insurance coverage.
Medical Coverage
8 definitions
Formulary
A list of prescription drugs covered by your plan, usually organized into cost tiers.
HDHP (High Deductible Health Plan)
A health plan with a higher deductible and often lower premiums. A qualifying HDHP is required to contribute to an HSA.
HMO (Health Maintenance Organization)
A plan that generally requires in-network care and referrals from a primary doctor for specialists.
PPO (Preferred Provider Organization)
A plan offering more provider flexibility, with lower costs when you stay in network.
Preventive Care
Routine care intended to prevent illness, such as checkups, screenings, and vaccinations. Many plans cover it at 100%.
Primary Care Physician (PCP)
Your main doctor for routine care and, in some plans, specialist coordination.
Referral
An authorization from a primary care doctor to see a specialist, commonly required by HMO plans.
Specialist
A clinician focused on a specific area of medicine, such as cardiology or orthopedics.
Dental Coverage
1 definition
Orthodontia
Treatment for misaligned teeth and jaws, including braces and retainers. Separate limits and waiting periods may apply.
Vision Coverage
2 definitions
Contacts Allowance
The amount a vision plan contributes toward contact lenses, often instead of glasses.
Frames Allowance
The amount a vision plan contributes toward eyeglass frames.
Life Insurance
5 definitions
Beneficiary
The person or people designated to receive a life-insurance or retirement benefit after your death.
Evidence of Insurability (EOI)
Medical or health information an insurer may require before approving certain coverage amounts.
Guaranteed Issue
Coverage available without medical underwriting or health questions, up to a stated limit.
Term Life Insurance
Life insurance covering a defined period. It has no cash value and is typically less expensive than permanent coverage.
Whole Life Insurance
Permanent life insurance with a cash-value component that can build over time.
Disability Insurance
3 definitions
Benefit Period
The maximum time disability benefits may be paid, such as two years or until age 65.
Elimination Period
The waiting period after a disability begins and before benefits become payable.
Own Occupation vs. Any Occupation
Own-occupation coverage focuses on your specific job; any-occupation coverage generally requires being unable to perform any suitable job.
Enrollment Process
5 definitions
Annual Enrollment
The yearly period when eligible employees can enroll in or change employer benefits.
COBRA
A federal continuation option that may let you keep employer health coverage temporarily after certain qualifying events, usually at your full cost.
Open Enrollment Period
A defined annual window when eligible people can enroll in, change, or cancel coverage.
Qualifying Life Event (QLE)
A major event—such as marriage, birth, or loss of other coverage—that may allow benefit changes outside annual enrollment.
Waiting Period
The time after becoming eligible or starting work before coverage begins.
Health Savings & Spending
3 definitions
FSA (Flexible Spending Account)
A pre-tax account for eligible health or dependent-care expenses. Plan-year and carryover rules apply.
Grace Period
Additional time after the plan year to incur eligible expenses or submit claims, depending on the plan.
HSA (Health Savings Account)
A tax-advantaged account for eligible medical expenses paired with a qualifying high-deductible plan. Funds can roll over year to year.
Supplemental Insurance
3 definitions
Accident Insurance
Supplemental coverage that pays stated benefits after covered accidental injuries.
Critical Illness Insurance
Supplemental coverage that may pay a lump sum after diagnosis of a covered serious illness.
Hospital Indemnity
Supplemental coverage that pays a stated benefit for covered hospital stays, independent of the provider bill.
Coverage & Benefits
5 definitions
Dependent
An eligible family member—such as a spouse, child, or domestic partner—who can be covered under a plan.
Network
The doctors, hospitals, pharmacies, and other providers contracted with an insurance plan.
Pre-existing Condition
A health condition that existed before coverage began. ACA-compliant health plans cannot deny coverage or charge more solely because of it.
Prior Authorization
Plan approval required before certain medications, procedures, or services will be covered.
Summary of Benefits and Coverage (SBC)
A standardized document summarizing what a medical plan covers and what members may pay, designed to make comparisons easier.