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Insurance Terms 101

To help you understand information related to your health insurance policy, we've gathered some basic terminology that may be helpful for you..

 

Allowed amount- The maximum dollar amount that is covered by an insurance company.

Benefits – The expenses covered for a period of time by the insurance health plan.

Claim – A formal request sent to the insurance company for service reimbursement.

Coinsurance - The percent of cost the individual shares with the insurance company. Example: The individual pays 30% after the deductible is met.

Copayment/Copay - Based on the insurance plan, a copayment is paid at the office visit. Example: $70 copay to be paid at the time of visit with the specialist.

Deductible - The year amount you pay for health care services before the insurance company starts to pay. Example: If the deductible is $500.00, this must be met before benefits are reimbursed by the insurance company.

Health insurance premium - The payment made upfront by the individual enroll or re-enroll in an insurance plan.

In-network - A provider or healthcare facility part of the benefits plan network. Example: A patient sees a provider affiliated with their benefits in-network plan. The patient is likely to pay less for services.

Out-of-network – A provider or healthcare facility is outside of the benefits plan network. Example: A student goes to see a physician that is not listed as an in-network provider for their health policy. They will pay more out-of-pocket for the services rendered.

Student health fee - The university health services fee is mandatory for undergraduate and graduate students. The health fee provides access to a professional medical care provider at the SHC, services at the Counseling and Psychological Services (CAPS) and Center for Wellness Promotion (CWP). The health fee is not health insurance. Students who pay the fee are eligible to utilize the services of the departments mentioned above, regardless of their health insurance type.