Look up · Glossary
Insurance words, said simply.
The words that make bills hard to read, in the way you'd explain them to a friend.
Twelve words worth knowing
Deductible
What you pay first before the plan starts to pay for many services.
Copay
A fixed amount you pay for a visit or a prescription.
Coinsurance
A share you pay after the deductible, like 20% of the bill.
Out-of-pocket maximum
The most you pay in a year. After that the plan pays more.
EOB
Explanation of Benefits. A statement about a claim. Not a bill.
Prior authorization
Approval from the plan before a service, for some services.
In-network
Providers that have an agreement with your plan.
Out-of-network
Providers without that agreement. You may pay more.
Waiting period
Time you wait before a benefit starts.
Exclusion
Something the plan does not cover.
Premium
What you pay to have the plan, often monthly.
Appeal
Asking the plan to look again at a decision.