Health Insurance Terms
chronic conditions - Ongoing medical conditions, such as asthma or diabetes.
claim - A request for payment that you or your health care provider submits to your health insurer when you receive care. Insurance claims are reviewed by your health insurer to make sure they are for covered services. If so, payment will be made in accordance with the terms and conditions of your health insurance plan.
coinsurance - The percentage you pay for some covered medical services. If your coinsurance is 20 percent, your health insurance company will pay 80 percent of the cost of covered services; you will pay the remaining 20 percent. The amount you pay is typically not based on the full price of the service. It is based on a discounted rate negotiated by your insurance company.
copay - Short for copayment, it’s a flat fee you pay when you see a doctor or receive other medical services. For example, a copayment could be $20 to see a doctor or $100 to go to the emergency room.
cost-sharing - Also known as out-of-pocket costs, it’s the amount of money you pay for a health care service, in the form of copays, deductibles, and coinsurance . This is in addition to the premium or monthly rate you pay to be a member of the health plan.