Terminology

This is what you are responsible meeting on your own in medical expenses before insurance pays towards expenses. 

Example: $0-$10,000 typically

The deductible plus this amount is your total loss before insurance cover expenses to the total policy cap they are willing to pay out.

Example: $500-$10,000 in addition to the deductible typically

Usually the secondary name on your insurance, this includes a group of doctors and medical care providers among various specialities, specified under the carrier how the insurance will contract with each facility on that specific plan.

Example: Bronze 5900, Connect 0, Choice Plus, Silver S01S, Gold G07L, ETC.

Is the big name brand behind your insurance. What facilities will file under.

Example: Blue Cross Blue Shield, Aetna, United Healthcare, Cigna, Ambetter, MultiPlan, etc.

Otherwise known as minimum essential coverage. Only the ACA and Obamacare plans include all levels of this for the security of the insured, all private market options not equired to include all 10.

Example: Ambulatory patient Services, Emergency Services, Pregnancy Maternity and Newborn care, Mental Health and substance use disorders including behavioral health treatment, Prescription drugs, Rehabilitative services, Hospitalization, Laboratory services, Preventative and Wellness Services, and Pediatric Services, and Oral and Vision care

This is how your Network and carrier come together with your direct provider, hospital, or physician to give you a percentage off of that visit.

Example: Can be anywhere from 0-90% depending on the facility or doctor your insurance files through

What the insurance company pays upto on a policy year or lifetime basis can be anywhere from 50,000-unlimited.

Example: not required to cover-unlimited based on the specific policy

Means that you never have to reenroll into health insurance, auto renewing typically allows for lower annual increases. Typically only subject to inflation.

Example: Sign up once and stay on until you are 65 ready for Medicare. Also, can cancel anytime

Whatever policy you choose to enroll into cannot deny you for having the coverage.

Example: All Obamacare plans

Typically have to go through an application. Can either consist of blood and urine or simple background and medical questionnare.

Example: Most private market options with the same full coverage carriers as guaranteed issued.

A fixed amount set aside by the insurance company for simple routine medical expenses.

Example: $25 for primary, $45 for speciality, $10 generic prescriptions

What the insurance company will pay towards medical expenses.

Example: $100 towards primary and speciality, $800 towards ER visits. (Can result in the insured getting paid for services depending on cost of provider)

What a health insurance policy will not cover, unless deemed medically necessary in unique scenarios. Can have separate caps for certain items.

Example: In-Vitro fertilization except in participating states

Basic routine services that aid in the prevention of illnesses, diseases or any other sicknesses. Most yearly visits and health screenings fall under these categories.

Example: Mammogram, pap smear, physical exam, colonoscopy, etc