Health Insurance Terms

Health Insurance is something we all need but it is not necessarily something we all understand.

Let’s try and understand it a little more with some fun Health Terms.


A health insurance program that offers eligible employees and their dependents extended health insurance coverage for the plan they’re on, in the event that they lose their job or their hours are reduced.

It stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, which is the law that first introduced COBRA insurance


A percentage you’ll pay for covered health services after you’ve met your annual deductible. Many plans offer 80/20 coinsurance, covering 80% of the cost of a service. That means you’ll pay 20%. So if you visit the doctor and it costs $100, you’ll pay $20.

Copayment (Co-pay)

More commonly referred to as a copay, this is a set amount you’ll pay for covered health services once you’ve met your deductible. Copays can vary depending on whether it’s for a medication, a visit to the doctor, or a lab test. If your insurance plan states that your copay for visits to the doctor is $20, that’s how much you’ll pay for that care.


The amount you’ll pay out of pocket for covered health services before your insurance plan starts to pay. For example, if your deductible is $2,500, you’ll pay $2,500 towards covered services before your insurance starts to pay. After that, you’ll typically only pay a copay or coinsurance for covered care.

Flexible Spending Account

An offering from your employer that allows you to pay for out-of-pocket healthcare costs with pre-tax money. Money is set aside from your paycheck and placed into this account before taxes are deducted from your income. You can typically use FSA funds for copayments, deductibles, certain prescription medications, and medical devices.

Generic Medication

Generic drugs have the same active ingredients, quality, and effect as brand-name drugs but are far less expensive.

High Deductible Health Plan

A health insurance plan with a high deductible. The amount of money you are responsible for paying out of pocket before your insurance begins paying is higher with this type of plan. However, monthly premiums with HDHPs are typically lower than those of other plans.


Stands for “health maintenance organization” and is a type of health insurance plan. HMOs work with specific doctors and hospitals to be part of its network of medical providers. These plans typically don’t cover any care from a provider outside of their network, except in the case of emergencies.


Referring to care or providers who are part of your insurance plan’s contracted network.


The doctors, hospitals, and suppliers your health insurer has contracted with to deliver healthcare services.

Open Enrollment

The period of time each year when you can enroll in a new health insurance plan.

Out of Network

Referring to care or providers who are not part of your insurance plan’s contracted network.

Out of Pocket (max out of pocket cost)

This is the maximum amount you’ll pay out of pocket in a given year. For 2020, the federally-enforced limits are $8,200 for individuals and $16,400 for families. Every health plan has its own out-of-pocket maximums, which may not be as high as the federal limits.


Stands for “preferred provider organization” and is a type of health insurance plan. PPOs have a network of participating providers that you’ll pay less to visit. You can visit facilities, doctors, and providers outside of the network for a slightly higher cost.
If you have more questions or would like more info on finding the RIGHT plan for you, let connect.  Fill out your info here and we can get started.

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