Glossary
Knowledge is power! Learn the lingo so you can be an informed consumer. Find definitions of commonly used health insurance terms in this glossary.
Underwriting
Find out more about what underwriting is and how it is used.
Find out more about what underwriting is and how it is used.
Death Spiral
Definition and explanation of the term "death spiral"
Definition and explanation of the term "death spiral"
Adverse Selection
Definition and explanation of the term "adverse selection"
Definition and explanation of the term "adverse selection"
Point of Service
Definition and explanation of the term "point-of-service."
Definition and explanation of the term "point-of-service."
Maximum Lifetime Payout
Definition and explanation of the term "maximum lifetime payout."
Definition and explanation of the term "maximum lifetime payout."
External review
Definition and explanation of the term "external review."
Definition and explanation of the term "external review."
Catastrophic Coverage
Definition and explanation of the term "catastrophic coverage."
Definition and explanation of the term "catastrophic coverage."
Referral
Learn more about referrals and when your health insurance may require them.
Learn more about referrals and when your health insurance may require them.
Pre-Approval
Definition of the term "pre-approval" in the context of health insurance.
Definition of the term "pre-approval" in the context of health insurance.
Out-of-Network
Learn about out-of-network providers.
Learn about out-of-network providers.
Personal Health Record
Definition and explanation of the term "personal health record"
Definition and explanation of the term "personal health record"
Electronic Medical Record
Definition and explanation of the term "electronic medical record."
Definition and explanation of the term "electronic medical record."
Consumer-Directed Health Care
Definition and explanation of the term "consumer-directed health care"
Definition and explanation of the term "consumer-directed health care"
Cost Transparency
Definition and explanation of the term "cost transparency"
Definition and explanation of the term "cost transparency"
Drug Importation
Definition and explanation of the term "drug importation"
Definition and explanation of the term "drug importation"
Open Enrollment
Open Enrollment defined
Open Enrollment defined
Medical Necessity
Medical Necessity defined
Medical Necessity defined
Major Medical
Major medical defined
Major medical defined
Guaranteed Issue
Guaranteed issue defined
Guaranteed issue defined
Cost Sharing
Cost sharing defined
Cost sharing defined
Explanation of Benefits (EOB)
Learn about your health plan's explanation of benefits.
Learn about your health plan's explanation of benefits.
High Deductible Health Plan
Learn about high deductible health plans and how they relate to health savings accounts (HSAs).
Learn about high deductible health plans and how they relate to health savings accounts (HSAs).
Prior Authorization
Learn about prior authorization requirements for prescription drugs.
Learn about prior authorization requirements for prescription drugs.
Formulary
Learn about formularies for prescription drug coverage.
Learn about formularies for prescription drug coverage.
Balance Billing
Learn about balance billing, a medical billing practice.
Learn about balance billing, a medical billing practice.
Flexible Spending Account
Learn about flexible spending accounts, a type of tax-advantaged account you can use for medical expenses.
Learn about flexible spending accounts, a type of tax-advantaged account you can use for medical expenses.
Community Rating
Find out what community rating is and how it can affect your health insurance premium. Learn about health insurance premium rating.
Find out what community rating is and how it can affect your health insurance premium. Learn about health insurance premium rating.
Mandated Benefit
Find out what mandated benefits are and whether your health insurance plan has them. Learn about requirements that health insurance companies must follow.
Find out what mandated benefits are and whether your health insurance plan has them. Learn about requirements that health insurance companies must follow.
Pre-existing Condition
Learn the lingo and find out more about what your insurer means by the term [i]pre-existing condition[/i].
Learn the lingo and find out more about what your insurer means by the term [i]pre-existing condition[/i].
Creditable Coverage
Definition of the insurance term "creditable coverage."
Definition of the insurance term "creditable coverage."
Annual Out-of-Pocket Maximum
Definition of "annual out-of-pocket maximum" and how it works in your plan.
Definition of "annual out-of-pocket maximum" and how it works in your plan.
HSA
Definition of HSA, or Health Savings Account
Definition of HSA, or Health Savings Account
Rider
Definition of rider
Definition of rider
Reasonable & Customary Fee
Definition of reasonable & customary fee
Definition of reasonable & customary fee
Capitation
Capitation defined
Capitation defined
Claim
Claim defined
Claim defined
Coinsurance
Coinsurance defined
Coinsurance defined
Copay
Copay defined
Copay defined
Deductible
Deductible defined
Deductible defined
HMO
HMO defined
HMO defined
Indemnity Plan
Indemnity Plan defined
Indemnity Plan defined
Pre-existing Condition Exclusions
Pre-existing Condition Exclusions defined
Pre-existing Condition Exclusions defined
PPO
PPO defined
PPO defined