| INSURANCE LINGO | TERMINOLOGY BREAKDOWN |
|---|---|
| PPO | Preferred Provider Organization - allows plan holders to visit a wide range of providers & hospitals. |
| HMO | Health Maintenance Organization - plan holders have a certain network of providers / hospital that they can visit. |
| DISCOUNT PLANS | Is not insurance. It provides a set discount on specified services only. Must see a participating provider / pharmacy to take advantage of the discount. |
| NETWORK | Providers & Hospitals that have contracted with the insurance carrier network. |
| OUT-OF-NETWORK | A provider that does not participate in the contract with the insurance carrier. |
| DEDUCTIBLE | A $ amount – maybe annual (or per occurrence) that must be paid by the member before the insurance company covers the remaining expenses related to that service. |
| MAXIMUM OUT OF POCKET AMOUNT | It is the combination of co pays deductible’s & the member portion % coinsurance that one could pay towards medical / Rx expenses within a calendar year i.e. January through December. |
| MONTHLY-PREMIUM | The amount you pay for the insurance. |
