Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider...

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the...

Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You...

A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the...

The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if...

An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. Back to Glossary Interested in...

Ambulance services for an emergency medical condition. Back to Glossary Interested in a Free Benefits Consultation? LET’S MEET

Health care services that your health insurance or plan doesn’t pay for or cover. Back to Glossary Interested in a Free Benefits Consultation? LET’S MEET

A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium. Back to Glossary Interested...

Care in a hospital that usually doesn’t require an overnight stay. Back to Glossary Interested in a Free Benefits Consultation? LET’S MEET

Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care. Back...

The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan....

A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network co-payments usually...

Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine....

The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. Back to Glossary Interested in a Free Benefits...

A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider....

The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance...

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This...

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called...

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law,...

Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions. Back to Glossary...

A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and...

The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical...

Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency...