Coverage

When you buy, or enroll in, a health plan, the insurance company agrees to pay for preventive services to help you stay well, plus part of your medical bills when you need a checkup, get sick, or have an accident.

In-network

If the doctor, hospital or health care facility you visit is part of your insurance company's network, you'll get your health care at lower prices. But if you go out of your network for health care, it can become a lot more expensive.

Out-of-network

Health care you receive without a physician referral, or services received by a non-network service provider. Out-of-network health care and plan payments are subject to deductibles and copayments.

Premium

Premiums are payments you make each month to your insurance company for your coverage.

Deductible

A specific dollar amount you pay out of pocket before benefits are available through a health plan. Under some plans, the deductible is waived for certain services.

Co-insurance

The amount or percentage that you pay for certain covered health care services under your plan. This is typically the amount paid after a deductible is met.

Co-payment

A flat fee that you pay toward the cost of covered medical services.

Out-of-pocket max

The highest out-of-pocket amount paid for covered services during a benefit period.

Subsidy

You may qualify for help from the government to pay part of your premium. This financial assistance is called a preimum tax credit or subsidy.