Glossary of Terms

Glossary of Health Insurance Terms

Confused about your coverage? Don’t be. You can find definitions for health insurance terms here, helping you understand everything from Medicare parts to deductibles and premiums.

Appeal: a request asking your health plan to review a ruling on coverage or payment. Learn more about appeals and grievances.

Brand Name Drug: a drug sold under a specific, trademarked brand name.

Claim: a request for payment from your health insurance provider for services, procedures or a drug.

Coinsurance: how health care costs are split with your insurance after your deductible is met.

Copayment: what you pay for a service when you receive it, like a doctor’s office visit or getting a prescription filled.

Deductible: the amount you must pay before your health insurance kicks in.

Formulary: a list of generic and brand name drugs chosen and covered by a health insurance plan.

Generic Drug: a drug with the same ingredients as a brand name drug but without the trademarked name. Generic drugs are usually covered by a health plan instead of brand name ones.

Grievance: a formal complaint about service and quality of a health plan or provider. Learn more about appeals and grievances

Maximum Out-of-pocket: a set amount capping what a member can spend on deductibles, coinsurance and copays for the policy period. After you meet the maximum out-of-pocket, your insurance will cover 100% of expenses.

Medicare: a health insurance program that assists people age 65 or older, along with some younger people with disabilities.

Medicare Part A: This is hospital insurance provided under Medicare. It covers hospital or nursing facility care, surgery, hospice and home health care.

Medicare Part B: Part B covers medical services including doctors’ care, outpatient care, labs, tests, medical equipment and some preventive care.

Medicare Part C: This allows private companies, like CHRISTUS Health Plan, to provide Medicare Advantage plans, which you can choose instead of original Medicare. These plans cover the same things as original Medicare Parts A and B, but they might have different restrictions and added benefits like prescription drug coverage, dental or vision care.

Medicare Part D: This is prescription drug coverage provided through private companies. You can choose to get a Part D plan that works with Medicare Parts A and B, or you can opt for a Part C Medicare Advantage plan, which will often have it included.

Premium: a monthly, quarterly or annual amount you pay for health insurance coverage.

Primary Care Provider: the doctor or nurse practitioner that is your main provider of health services.

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Last Updated: 2/23/17