Helpful Terms & Resources

Common Terms & Definitions

Copay (Copayment)
A fixed amount you pay for a covered healthcare service, such as a doctor’s visit or prescription, usually due at the time of service.

Deductible
The amount you pay out of pocket for covered healthcare services before your plan begins to pay.

Coinsurance
Your share of the cost of a covered service, calculated as a percentage (for example, 20%) after you’ve met your deductible.

Out-of-Pocket Maximum
The most you’ll pay for covered healthcare services in a plan year. Once you reach this limit, your plan typically pays 100% of covered costs.

Premium
The amount you pay (usually per paycheck) to maintain your health insurance coverage.

In-Network vs. Out-of-Network
In-network providers have contracted rates with your insurance plan, typically resulting in lower costs.
Out-of-network providers do not have agreements with your plan and usually cost more.

Health Savings Account (HSA)
A tax-advantaged account you can use to pay for eligible healthcare expenses. HSAs are typically paired with high-deductible health plans, and unused funds roll over year to year.

Flexible Spending Account (FSA)
A pre-tax account used for eligible healthcare or dependent care expenses. FSAs may have a “use it or lose it” rule, depending on your plan.

Preventive Care
Routine services like annual checkups, screenings, and immunizations that are often covered at no cost when you use in-network providers.

Explanation of Benefits (EOB)
A statement from your insurance provider that explains what was billed, what the plan paid, and what you may owe.

Balance Billing
When a provider bills you for the difference between what your insurance plan pays and the provider’s full charge. This most often happens when you see an out-of-network provider, and it can result in higher out-of-pocket costs.

Open Enrollment
The annual period when you can enroll in or make changes to your benefit elections.

Qualifying Life Event
A major life change — such as marriage, birth of a child, or loss of other coverage — that allows you to update your benefits outside of open enrollment.

Beneficiary
The person (or people) you designate to receive benefits, such as life insurance or retirement funds, in the event of your passing.

Employee Assistance Program (EAP)
A confidential resource that offers support for personal, financial, or work-related challenges, often including counseling and referrals.