Understanding Insurance Terms

Trying to understand insurance terms when you are seeking help for an addiction can be challenging. For that reason, we wanted to present you with a brief guide on how to understand some of the many terms that insurance companies use.

Deductible – The amount you owe for covered healthcare services before your health insurance carrier begins to pay.

Co-payment – An amount you pay as your share of the cost for a healthcare service or item.

Coinsurance – Your share of the cost for a health care service, usually calculated as a percentage (e.g., 30%) of the allowed amount for the service.

Premium – The amount you pay for your health insurance or plan each month.

Network – The service providers (e.g., doctors, treatment centers, hospitals, etc.) your health insurance carrier has contracted with (and negotiated a rate) to deliver health services to their members.

Out-of-Pocket Costs – Your expenses for care that are NOT reimbursed by insurance. Typically, these costs include deductibles, coinsurance, and co-payments for covered services, plus all costs for services that are not covered.

Out-of-Network Benefits – Out of Network benefits (usually covered with PPO plans) help pay for your provider of choice that is not contracted with your insurance carrier.

Out-of-Pocket Maximum Limit – The most you will have to pay for a covered service in a plan year. After you spend this amount on deductibles, co-payments, and co-insurance your health plan will pay for 100% of the costs of covered benefits.

*Definitions found at healthcare.gov.

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