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Health Insurance Glossary​

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Health Insurance, like people, comes in all shapes and sizes. There are many different coverage options to best fit you, your family, and the care you need. Some things may simple and other a foreign language – Here are definitions of some of the common terms you may come across as you’re shopping for health insurance.

Deductible

In an insurance policy, the deductible is the amount paid out of pocket by the policy holder before an insurance provider will pay any expenses. In general usage, the term deductible may be used to describe one of several types of clauses that are used by insurance companies as a threshold for policy payments.

Co-Insurance

The amount of medical costs the patient pays after paying the health insurance plan deductible. Co-insurance is usually a percentage of the cost and is defined in the health plan. It sometimes varies according to the type of service provided.

Open Enrollment

The period of time each year when employees can change insurance plans offered through their employer.

Pre-Existing Condition

A health condition for which a patient received treatment before enrolling in a health insurance plan. Individual insurance policies may exclude certain pre-existing conditions from coverage. Under health care reform, insurers will not be able to exclude coverage for pre-existing conditions starting in 2014.

Co-Payment

A co-payment is a fixed amount of money that a person has to pay for a medical service, such as going to the doctor or filling a prescription. For example, if a person's health insurance plan has a co-payment of $20 for a doctor's visit, the person would have to pay $20 out of their own pocket every time they go to the doctor, even if their insurance covers the rest of the cost.

Specialist

In the medical profession, a specialist is a doctor who has completed additional training in a specific area of medicine, such as cardiology or neurology. This additional training allows the doctor to provide more specialized and in-depth care to patients who have conditions that fall within their area of expertise. Specialists are typically considered to be experts in their field, and patients may see them for more complex or difficult-to-diagnose medical issues.

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