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Health care services covered with some level of payment by your insurance plan.
A percentage of the charges for a health care service that you pay.
A flat fee you pay for some services and prescriptions.
Also called benefits, these are services included in your health plan. You and your insurer will share the cost of them. All covered services count toward your deductible and out-of-pocket maximum.
How much you pay each year before your insurance starts to pay. There are two types:
- Non-embedded deductible: Everyone on the plan shares one family deductible.
- Embedded deductible: Each family member has their own deductible, in addition to a shared family one.
Health insurance marketplace
A government-sponsored online store where companies offer policies. You must buy your plan through the marketplace to get financial assistance (tax credit/subsidy).
Health savings account (HSA)
A special bank account that helps you set aside money for medical expenses, tax-free. You must enroll in a High-Deductible Health Plan to apply these funds to your insurance benefits.
Your network includes doctors, clinics, hospitals, pharmacies, and other providers. They contract with your insurer to provide services at discounted rates. Your benefits will only apply to providers in your plan's network.
Some services aren't included in your health plan (also called exclusions). You pay the full cost of those services. Payments for non-covered services don't count toward your deductible or out-of-pocket maximum. Examples are cosmetic procedures, test drugs, and refractive eye surgery.
This is a limit on what you pay in a year for covered services. Deductibles, copays, and coinsurance count toward this amount. Premiums don't.
Explore our glossary to find definitions of more commonly used terms.
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