Glossary

Copay – Amount paid by the insured person to the health service provider at the time of the service (appointment with a doctor, lab test, pharmacy, etc.)

Deductible – Amount the insured person pays before the insurance company starts to pay (‘kicks in’) 

• Plans with lower premiums usually have higher deductibles

Explanation of benefits (EOB) – Statement sent by the insurance company to the subscriber outlining what the insurance company will pay and what the subscriber is responsible for paying

Insured persons – Family members who are covered by the insurance policy

Network – Health care providers who have a contract with your insurance company are in your network. Fees are generally less if you see providers 'in-network'

Participation – When a provider like the health center has a contract with an insurance company

Premium – The amount the subscriber must pay to the insurance company in order to obtain coverage

• Payments may be lump sum or installment
• Employer may cover the premium, or 'co-share' the premium with the employee

Pre-authorization – Some medical services may need pre-approval from an insurance company before services are covered

Primary/Secondary – Some people have two different insurance plans. It is the patient’s responsibility to know which company should be billed first.

Referral – Recommendation from one health care professional to another. This may be mandated by your insurance company.

Subscriber/member – The person who is paying for the insurance policy