Glossary
Look up a benefis-related team below:
Urgent Care
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not Read More
UCR (Usual, Customary and Reasonable)
The amount paid for a medical service in a geographic area based on what providers in the area usually charge Read More
Specialist
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or Read More
Reconstructive Surgery
Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries Read More
Primary Care Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician Read More
Preauthorization
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical Read More
Out-of-Pocket Limit
The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay Read More
Out-of-network Co-insurance
The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do Read More
Non-Preferred Provider
A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay Read More
Medically Necessary
Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and Read More
In-network Co-payment
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health Read More
In-network Co-insurance
The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract Read More
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay. Back to Glossary Interested in a Free Benefits Consultation? Read More
Hospitalization
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for Read More
Health Insurance
A contract that requires your health insurer to pay some or all of your health care costs in exchange for Read More
Excluded Services
Health care services that your health insurance or plan doesn’t pay for or cover. Back to Glossary Interested in a Read More
Emergency Medical Transportation
Ambulance services for an emergency medical condition. Back to Glossary Interested in a Free Benefits Consultation? LET’S MEET
Emergency Medical Condition
An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe Read More
Deductible
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan Read More
Co-Payment
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. Read More
Co-Insurance
Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the Read More
Balance Billing
When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the Read More
Allowed Amount
Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” Read More