Benefits: The medical services included in a health insurance policy to which the insured person or persons are entitled.

Calendar Year: The time period from January 1 to December 31 in a single year.

Catastrophic Health Insurance: Insurance, with a very high deductible, covering an injury or illness with medical expenses that are above the normal parameters of basic health insurance.

Claim: A health-related bill submitted for payment to a health insurance company by the policy holder or health care provider.

COBRA: “Consolidated Omnibus Budget Reconciliation Act” of 1985 is a regulation that affects most U.S. employers of over 20 employees, whereby they must offer departing employees a continuation of their health insurance; it includes other options.

Co-insurance: The amount of money a health plan will pay for covered expenses, usually expressed in a percentage.

Co-payment: The dollar amount the policyholder pays at each visit for a medical service; it varies according to each insurance policy.

Coverage: A health service which qualifies as a benefit under the terms of an insurance contract.

Deductible: The amount of money the policyholder pays for medical bills before insurance starts to pay its part. This is a yearly amount and may be anywhere from several hundred dollars to several thousand per year, depending on the insurance policy.

HIPAA: “Health Insurance Portability and Accountability Act” gives patients a means to the documents which pertain to their medical care; provides that a person with a pre-existing condition, who has had continuous health coverage for over 12 months, can leave a job and not be turned down for health insurance at a new job.

Maximum Limits: The highest dollar amounts a health insurance plan will pay: 1) for a single claim; 2) over the lifetime of an insured person.

Network: The doctors or other medical providers and facilities that either work for or contract with a group health care organization

Out-of-Network: Doctors or other medical providers and facilities which either do not work for or which do not contract with a group health care organization.

PCP: “Primary Care Physician” or “Personal Care Provider” is a physician or other medical care provider who participates in a health care system.

Policy: The legal agreement between an insurance company and insured person, whereby the company agrees to pay for the covered medical services included in the agreement and the insured agrees to pay the premium price

Pre-existing Condition: A physical or mental condition which existed before applying for a policy, for which medical care was already recommended or received, and which may not be covered by insurance, or only after a time lapse.

Premium: The money paid by an insured person or business for a health insurance policy.

Provider: A physician, hospital, medical care facility, or other type of medical personnel who provide health care.

Referral: The method whereby a physician directs a patient to the services of another physician.