Pays an insured a percentage of their monthly earnings if they become disabled.

A documentation of services provided which you or your service provider submit to your insurance company for consideration of payment.

A medical delivery system that attempts to manage the quality and cost of medical services which individuals receive. Most managed care systems offer PPOs that individuals are encouraged to use for their health care services. Some managed care plans attempt to improve health quality by emphasizing prevention of disease.

Your share of the costs of a covered healthcare service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $80 and you’ve met deductible (if applicable), your coinsurance payment of 20% would be $16. The health insurance or plan pays the rest of the allowed amount.

The maximum amount of money that an insurance company (or self-insured company) will pay for claims within a specific time period. Maximum dollar limits vary greatly. They may be based on or specified in terms of types of illnesses or types of services. Sometimes they are specified in terms of lifetime or sometimes for a year.

A fixed flat dollar amount (for example, $10 or $15) that you pay toward a covered healthcare service, usually when you receive the service.

A group of doctors, hospitals and other health care providers contracted to provide services to an insurance company’s customers for less than their usual fees. Provider networks can cover a large geographic market or a wide range of health care services. Insured individuals typically pay less for using a network provider.

On some plans and / or benefits: the yearly amount you may owe for healthcare services before your health insurance begins to pay benefits. For example, if your deductible is $300, certain benefits subject to deductible will not have anything paid by insurance until you have met your $300 deductible cost sharing for those covered services. Some plans may not have deductibles, others may have separate or combined deductibles for medical, dental and/or vision benefits. If your plan has a family maximum on the deductibles, once the sums among the covered family members have accumulated and reach the family max, the deductible is deemed met for all family members for the remainder of that Policy year. Remember to submit your claims to your insurance Company so they know you have made the payments which could count toward deductibles.

This phrase usually refers to physicians, hospitals or other health care providers who are considered non-participants in an insurance plan. Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.

Refusal by an insurance company to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.