Here are some basic medical and insurance terms that will
help you understand health care in the United States better.
A request by the insured individual for payment by the insurance company of
The percentage that the insured person pays after the deductible is paid. The
copayment may be a specific amount , or may be expressed as a percentage. For
example, if the insurance company pays 80 percent of covered charges, then the
copayment is 20 percent.
Any expense which is paid for under the insurance policy.
Costs for services such as doctor visits, surgery, hospitalization, x-rays, prescription drugs,
etc, are usually forms of covered expenses.
The amount that the insured person must pay before the insurance company starts
paying. For example, if your deductible were $50, then you would have to
pay the first $50 of the covered medical costs before the insurance will pay
anything at all.
Any expense that under the terms of the insurance policy your insurance company
will not pay for.
Fee for service
A fee that must be paid to the doctor, clinic, or other medical professional at
the time that service is provided. These fees are paid immediately after
treatment is received.
Insurance (HMO) identification card
This card is a sort of membership card provided by your insurance company or
HMO. It shows your name, the number of your policy, and the address and
telephone number to call for claims and questions. You must show your card
whenever you go for treatment.
A written contract defining the terms and conditions of your insurance plan. It
will detail out what it covers, any exclusions, eligibility requirements, and
all the benefits and conditions that apply to you while under the plan.
The amount of money you pay to be under a specific insurance policy for a given
period of time. The premium may be paid monthly, quarterly, semi-annually, or
annually depending on the policy agreement.
Lapse in coverage
A break in insurance coverage. This is usually a result of nonpayment of
A medical condition that existed before an insurance policy was purchased.
Steps taken to prevent the onset of a disease or prevent illness or injury.
Paying a premium in order to continue coverage after the initial policy period