Health Insurance Glossary
Health insurance terms, explained simply
Definitions from HealthCare.gov, paired with practical context so you can pick a plan that actually fits. Use search to find a term, or browse the full list below. Understand deductibles, premiums, copays, HMOs, PPOs, and everything in between.
Showing 24 of 256 health insurance terms
GeneralHealth Savings Account (HSA)
A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars…
GeneralUncompensated care
Health care or services provided by hospitals or health care providers that don't get reimbursed. Often uncompensated care arises when…
GeneralCo-op
A non-profit organization in which the same people who own the company are insured by the company. Cooperatives can be formed at a…
GeneralOut-of-network copayment
A fixed amount (for example, $30) you pay for covered health care services from providers who don't contract with your health insurance or…
MedicaidMedicaid
A joint federal and state insurance program that provides free or low-cost health coverage to some low-income individuals, families,…
GeneralRisk adjustment
A statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when…
GeneralAnnual limit
A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are…
GeneralHome and community-based services (HCBS)
Services and support provided by most state Medicaid programs in your home or community that gives help with such daily tasks as bathing or…
GeneralQualifying life event (QLE)
Like getting married, new baby or dependent, moving, or losing health coverage.
GeneralCreditable coverage
Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare;…
Employer PlansGroup health plan
In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
GeneralHealth coverage
Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company, a…
MedicareMedicare
A federal health program for people 65 and older and certain younger people with disabilities and ESRD.
GeneralPreferred provider
A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you…
GeneralPayment bundling
A payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall…
GeneralNet rental income
The amount someone pays you to use your property, after you subtract the expenses you have for the property. Royalty income includes any…
GeneralDrug list
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called…
GeneralGuaranteed renewal
A requirement that your health insurance issuer must offer to renew your policy as long as you continue to pay premiums. Except in some…
GeneralTRICARE
A health care program for active-duty and retired uniformed services members and their families.
GeneralAllowed amount
The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or…
GeneralNondiscrimination
A requirement that job-based coverage not discriminate based on health status. Coverage under job-based plans cannot be denied or…
GeneralIndividual Coverage Health Reimbursement Arrangement
A type of Health Reimbursement Arrangement that reimburses medical expenses, like monthly premiums, and requires eligible employees and…
GeneralService area
A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit…
GeneralSelf-insured plan
Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility…
Showing 1–24 of 256 results
Common Questions About Health Insurance Terms
Health Insurance Definitions by State
Health insurance rules, marketplace plans, and Medicaid eligibility vary by state. Explore state-specific guides to understand how terms apply where you live.
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