Preferred Companies
- Aetna
- Blue Cross Blue Shield
- Gerber Life
- Genworth
- Guardian
- Humana
- Mutual of Omaha
- Transamerica
- United Healthcare
- Other "A" Rated Companies
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Glossary of Common Insurance Terms |
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These terms are provided as general definitions. Please consult your insurer to review the specifics for your individual plan.
Deductible
This is the amount you must pay each year to cover your medical care expenses before your insurance policy starts paying. Deductibles will vary by plan.
Copayment
This is the flat fee amount you pay every time you receive a medical service such as an office visit or prescription. Copayments will vary by plan.
Coinsurance (Sharing the Costs)
This is the amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example if the insurance company pays 80% of the claim, you pay the remaining 20% of eligible expenses.
Pre-Existing Conditions
A condition is considered pre-existing if, during a period immediately prior to your effective date of coverage, you received medical treatment, diagnosis, consultation, or took prescription drugs for a health problem, sickness or injury OR if medical advice, diagnosis, care or treatment was recommended before your insurance became effective. Plans will not pay benefits for charges incurred due to a pre-existing condition, unless you had prior coverage or until you have met a time requirement.
Maximum Out-of-Pocket
This is the most that you pay out-of-pocket before your plan pays 100% of benefits. Out-of-pocket expenses include deductibles and coinsurance. It is a stated dollar amount set by the insurance company and does not include regular premiums or ineligible expenses.
Preventive Care
Preventive care benefits typically include routine physicals, well-child care, immunizations, and routine exams with diagnostic lab testing at reduced rates (or copay prices), even if the deductible has not been met. Benefits will vary by plan.
Premium
This is the amount you or your employer pays in exchange for insurance coverage.
Preauthorization
When you need inpatient treatment or certain outpatient procedures, you must notify your insurance carrier and verify that they will share the cost of the procedure. Preauthorization may be necessary in order to get coverage benefits.
Medical Savings Accounts or Health Savings Account
This is a savings account created for the purpose of paying qualified medical, dental or vision expenses. A savings account allows tax-deductible contributions and tax-deferred or tax-free interest. This account can build throughout your lifetime. There is no “use it or lose it” provision.
Generic Drugs
Generic drugs are pharmaceutically and therapeutically equivalent to brand-name drugs. They are the most affordable drugs and generally offer lower copays.
Disability Insurance
If you have a long-term illness or injury and cannot work, disability insurance replaces a portion of lost income.
Long-Term Care Insurance
Long-term care insurance is designed to cover the costs of nursing home or in-home care. There are many plans and they vary in costs and services covered, each with its own limits.
Premium Waiver
With a life insurance policy, premium waiver pays your policy premium if you are totally disabled.
Accidental Death
Accidental death benefits provide an additional death benefit to the amount of the basic life insurance policy.
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