Useful Terms and Symbols

Coinsurance: The money you have to pay for health services after you have paid the deductible

Copayments: The fee paid for a doctor visit, hospital stay or other service

Deductible: The amount of money you pay before your insurance starts to pay

Eligible expense: A service or product recognized by the IRS that is purchased to help treat a medical condition or prevent a disease

Employee contribution: The money an employee pays to be covered by a health plan; also called “premium”

Flexible Spending Account (FSA): An employer sponsored account in which pre-tax funds are set aside from an employee’s paycheck each year. FSA funds can be used for eligible medical expenses, dependent care or commuter expenses, as determined by the IRS

Health Maintenance Organization (HMO): A kind of health insurance plan that usually requires members to receive services through doctors, labs, and hospitals that contract or work with the HMO

Health Reimbursement Account (HRA): Health care accounts that employers fund for covered workers or retired persons; IRS does not tax this money; also call Health Reimbursement Arrangements

Health Savings Account (HSA): Health care bank accounts that let people put money aside tax free to pay for medical, dental and vision costs; IRS limits who can open and put money into HSA; money in HSA stays in the account until it is used

Network provider: All the doctors, hospitals, nursing homes and laboratories that have contracts with an insurance company; also called “in-network” provider and “participating network” provider

Non-network provider: Doctors, hospitals, and other health care professionals who do not participate in our network and may provide services at a higher cost

Out-of-pocket maximum: The most you have to pay for health services; once paid, the insurance company pays 100 percent of eligible health care costs

Point-of-service (POS): A health benefit plan that allows the covered person to choose to receive service from a participating or non-participating physician or other health care provider, with different benefit levels associated with the use of participating physicians or other health care providers

Preferred Provider Organization (PPO): An organization where providers are under contract to provide care at a discounted or negotiated rate