Benefit Terms & Definitions

Learn the lingo.

To better understand your coverage, being familiar with benefits vocabulary is helpful. Take a moment to review these terms, which may be referenced throughout this guide.

Balance Bill – When a health care provider bills a patient for the difference between what the patient’s health insurance chooses to reimburse and what the provider chooses to charge.
Copay – A fixed dollar amount you pay the provider at the time of service; for example, a $25 copay for an office visit or a $10 copay for a generic prescription.
Coinsurance – The percentage paid for a covered service, shared by you and the plan. Coinsurance can vary by plan. Review the plans carefully to understand your responsibility. You are responsible for coinsurance until you reach your plan’s out-of-pocket maximum.
Deductible – The amount you pay each calendar year before the plan begins paying benefits. Not all covered services are subject to the deductible; for example, the deductible does not apply to preventive care services.
Emergency Room Care – Care received at a hospital Emergency Room for life-threatening conditions.
Evidence of Insurability (EOI) – The process of providing health information to qualify for certain types of insurance coverage.
In-Network Care – Care provided by contracted doctors within the plan’s network of providers. This enables participants to receive care at a reduced rate compared to care received by out-of-network providers.
Out-of-Network Care – Care provided by a doctor or at a facility outside of the plan’s network. Your out-of-pocket costs may increase and services may be subject to balance billing.
Out-of-Pocket Maximum – The maximum amount you pay per year before the plan begins paying for covered expenses at 100%. This limit helps protect you from unexpected catastrophic expenses.
Premium – The complete cost of your plans. You share this cost with your employer and pay your portion through regular paycheck deductions.
Preventive Care – Routine health care including annual physicals and screenings to prevent disease, illness, and other health complications. In-network preventive care is covered at 100%.
Urgent Care – Care provided at an Urgent Care Center for sudden illnesses or injuries that are not life-threatening. Urgent Care Centers are helpful when care is needed quickly to avoid developing more serious pain or problems.

Benefit Acronyms

Here’s your cheat sheet on all the benefit acronyms we use around the site.

AD&D	EAP	EPO	FSA
Accidental Death & Dismemberment	Employee Assistance Program	Exclusive Provider Organization	Flexible Spending Account
HDHP	HMO	HSA	LTD
High Deductible Health Plan	Health Maintenance Organization	Health Savings Account	Long-Term Disability
OOPM	PPO	QLE	STD
Out-of-Pocket Maximum	Preferred Provider Organization	Qualified Life Event	Short-Term Disability