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  • Home
    • Insurance
    • Health Plan Vocabulary
  • Network

    Health care providers who agree to work with a health plan to provide services to

  • Preferred Provider Organization (PPO) Plan

    A type of health plan that contracts with medical providers —such as hospitals an

  • Exclusive Provider Organization (EPO) Plan

    A managed care plan where services are covered only if you go to doctors, special

  • High Deductible Health Plan (HDHP)

    A plan with a higher deductible than a traditional insurance plan because it is d

  • Benefit

    This describes the portion of your claims costs that are covered by your health p

  • Claims

    These are your health care expenses that are filed with your insurer to request p

  • Co-insurance

    This term refers to the percentage of costs of a covered health care service for

  • Co-pay

    This fixed, out-of-pocket payment is made by the plan participant at the time a m

  • Deductible

    Generally speaking, a deductible is the predetermined amount of money a participa

  • Maximum out-of-pocket (MOOP)

    The maximum out-of-pocket limit includes the deductible, co-pays and co-insurance

  • Co-insurance and deductible out of pocket limit (out-of-network)

    The most you will have to pay in a year in out-of-network deductibles and co-insu

  • Emergency Care

    Medical services from the Emergency department of a hospital to evaluate a medica

  • Primary Care Provider

    This type of doctor or medical practitioner provides preventive and routine care.

  • Specialist

    A doctor or medical practitioner with advanced training in a specific subset of c

  • Retail pharmacy benefits

    This refers to filling your prescriptions at a participating network pharmacy. Th

  • Prescription Formulary

    Also known as a preferred formulary, this is a list of prescription drugs covered

  • Prescription Tiered Pricing

    Co-pays for prescription drug prices are differentiated by the levels or tiers. T

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