Terms To Know

  • Co-Insurance: The portion or share of your medical bill you still have to pay after you have met your deductible. This will usually be a percentage of the bill.
  • Co-Payment: A pre-set amount (based on your plan) you pay for care at the time you see the doctor.
  • Deductible: A pre-set amount (based on your plan) that you will have to pay before your health insurance begins to pay its portion. If the service has a co-pay then you pay only the co-pay, even if you have not paid the amount of your deductible yet.
  • Emergency Medical Condition: An illness or injury so serious you would get care right away s to avoid serious harm or death.
  • Emergency Medical Transportation: Ambulance services for an emergency medical condition.
  • Emergency Room Care: Emergency Services you get in an emergency room of a hospital.
  • Excluded Service: Medical care that your health insurance plan will not pay for.
  • Habilitation Services (also called Rehabilitation services): Care that helps a person keep, learn or improve skills needed for daily living.
  • Health Insurance: An agreement that requires your health insurance company to pay some of your medical bills in exchange for a premium (monthly payment). Your health insurance company will provide a list of what coverage you have.
  • Health Insurer: a company who has health insurance plans available for people to buy which help pay for the cost of medical care. Also called your “insurance company.”
  • Hospitalization: You must be taken care of in the hospital as a patient. Usually you will need to stay in the hospital at least overnight.
  • Network: Doctors and doctor’s offices that have made an agreement with the health insurance company to provide you with medical services if you want them to.  These doctors contract with your insurance company at a certain rate.
  • Non-preferred provider: Doctor that does not have an agreement with your health insurance company to provide you with medical care. You will normally have to pay more to see these doctors than you will preferred providers.
  • Plan: See health insurance.
  • Preferred Provider: a doctor that has made an agreement with your health insurance company to provide medical services to you at a lower rate. You will pay less to see these doctors than a non-preferred provider.
  • Premium: the set monthly amount you pay to the insurance company. This amount must be paid each month even if you do not receive any medical care that month or your contract will be cancelled.
  • Prescription Drug: medicine that must be prescribed by the doctor and filled at a pharmacy.
  • Prescription Drug Coverage: health insurance that helps pay for prescription medications.
  • Primary Care Provider: a doctor who organizes and helps manage your entire healthcare needs. This type of doctor would give you your yearly check-up or see you when you are sick.
  • Rehabilitation Services: See Habilitation Services.
  • Urgent Care: medical care for an illness or injury serious enough that you would need help right away, but not so serious as to need to go to the emergency room, when most doctors offices are closed. They operate like a normal doctors office but are open later and on weekends/holidays.  


Key Terms to know on your Insurance Card

key terms on insurance card


Primary Care vs. Emergency Care

Primary vs. Emergency