- Deductible
- The fixed dollar amount the insured must pay out of pocket for covered medical expenses before the insurer begins to pay benefits.
- Copayment
- A flat, fixed dollar amount the insured pays for a specific covered service, such as a doctor visit or prescription, at the time the service is received.
- Out-of-Pocket Maximum
- The most the insured will have to pay for covered expenses in a policy period; once reached, the insurer pays 100% of remaining covered costs.
- Underwriting
- The insurer's process of evaluating an applicant's risk to decide whether to issue coverage and at what premium rate.
- Rider
- An amendment attached to a policy that adds, modifies, or excludes coverage, allowing the policy to be tailored to the insured's needs.
- Pre-existing Condition
- A medical condition that existed before the effective date of a health insurance policy, which may affect coverage eligibility or benefit waiting periods.
- Elimination Period
- A waiting period after a disability or loss begins during which no benefits are paid, functioning like a time-based deductible common in disability income insurance.
- Beneficiary
- The person or entity designated to receive policy benefits, such as a death benefit, upon the occurrence of the insured event.
- Guaranteed Renewable
- A policy provision under which the insurer must renew coverage as long as premiums are paid, though it may raise premiums by class, but not for an individual insured.
- Managed Care
- A health delivery system, such as an HMO or PPO, that controls costs and coordinates care through provider networks, utilization review, and negotiated rates.
- Premium
- The amount of money the policyowner pays to the insurer to keep a health insurance policy in force, typically on a monthly, quarterly, or annual basis.