Glossary

Commonly Used Terms

coinsurance — A percentage of a covered service that you are responsible for paying or the percentage paid by your plan.

contracting hospital — A hospital which has an agreement with a health care plan to provide hospital services to members of that plan.

deductible — A fixed amount you are required to pay before health care benefits begin.

Explanation of Benefits (EOB) — An EOB is created after a claim payment has been processed by your health care plan. It explains the actions taken on a claim such as the amount that will be paid, the benefit available, reasons for denying payment and the claims appeal process. EOBs are available both as a paper copy and online.

in-network services — Services provided or coordinated by your primary care physician (PCP) and paid at a higher benefit level.

network — The group of doctors, hospitals and other medical care professionals that a managed care plan has contracted with to deliver medical services to its members.

non-contracting hospital — A hospital that has not contracted with a health care plan to provide hospital services to members in that plan.

out-of-pocket maximum — The maximum amount you pay for expenses covered under your health care plan, after any deductible is met, during a defined benefit period.

out-of-network — Services provide by doctors and hospitals who have not contracted with your health plan.