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Campus Resources

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 by a period of time by the insurance health plan.

BIN- pharmacy utilizes this number to identify which insurance plan to process.

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.

Group Number- the insurance company identifier is used for processing the correct insurance details under the payer.

Healthcare Clearinghouse- Transmits various medical claims data to the insurance carriers.

Health Insurance Portability and Accountability Act (HIPAA)- The Health Insurance Portability and Accountability Act of 1996 is a federal law that is required with national standards to protect the privacy and security of patient information without notice or consent.

Identification Number (ID)- this number is important to provide for services at the doctor or pharmacy. Majority of the time, this number is below the name on the insurance card.

Medicaid- Health insurance program for low-income families who need assistance with health care costs.

PCN- Identifies drug benefit processors to determine the type of benefits package. It is used for routing pharmacy transactions.

Third party billing/ Commercial Payer- Also known as private insurance is coverage that is not associated with government payers such as Medicaid or Medicare. 

Click this link to see an example insurance card.