Medical Insurance 101: Commonly Known as Health Insurance

Health issues diagnosed before the start of a new insurance policy. Coverage may vary based on the policy and provider.

Expenses you must pay yourself, including deductibles, co-payments, and co-insurance. Limits vary by plan and provider.

The amount you pay regularly (monthly, quarterly, or annually) to keep your insurance policy active. Rates vary based on coverage.

The amount you must pay for healthcare services before your insurance begins to cover costs. Higher deductibles often mean lower premiums.

A fixed fee you pay for specific medical services, such as doctor visits or prescriptions, in addition to what your insurance covers.

The percentage of medical costs you share with your insurance after meeting your deductible. Common splits are 80/20 or 70/30.

Immediate medical care coverage for sudden, serious conditions. Includes ER visits and urgent treatments, subject to plan specifics.

Coverage for emergency transportation to hospitals. Policies vary on coverage limits and whether both ground and air transport are included.

Coverage for medical treatments and surgeries requiring hospital stays. Typically includes room, board, and necessary medical services.

Coverage for medical services that do not require overnight hospital stays, such as doctor visits, lab tests, and minor surgeries.

Healthcare providers and facilities that have agreements with your insurance plan, often resulting in lower costs for services.

Healthcare providers and facilities not contracted with your insurance, often leading to higher out-of-pocket costs for services.

Coverage for medications prescribed by a doctor. Plans vary in terms of covered drugs, co-pays, and formularies.

Coverage for prenatal, childbirth, and postnatal care. Includes doctor visits, hospital stays, and necessary medical services.

Coverage for mental health services, including therapy, counseling, and psychiatric care. Coverage details vary by plan.

Coverage for dental services such as cleanings, exams, and procedures. Often requires separate or additional plans.

Coverage for vision-related services, including eye exams, glasses, and contact lenses. May require a separate vision plan.

Maximum amount an insurance plan will pay for a specific condition. Costs beyond this limit are the policyholder’s responsibility.

The total amount an insurance policy will pay over its term. Once reached, the policyholder must cover all additional costs.

Specific conditions or treatments not covered by an insurance policy. Important to review exclusions to understand coverage limits.