The insurance company offering a health plan.

Case management is a system embraced by employers and insurance companies to ensure that individuals receive appropriate, reasonable health care services.

The printed description of the benefits and coverage provisions forming the contract between the carrier and the customer. Discloses what is covered, what is not, and dollar limits.

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

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.

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

When you pay some of the costs of your healthcare.

Any person covered under the plan.

Charges for services that your insurance plan will pay for. Not all services billed will be covered. Different plans and different insurance providers cover different services.

A coding system using 5 number codes that providers put on requests or claims to describe the services they are proposing or have done.