A type of funding arrangement that are subject to state insurance regulations, whereas self-insured health plans are not – they’re regulated at the federal level instead, under ERISA.

A type of health insurance plan that requires you to choose a primary care doctor who coordinates your care and refers you to specialists within the HMO network.

A process that insurance companies use to determine whether a patient is eligible to receive certain procedures, medications, or tests, except in an emergency.

A type of funding arrangement offered by an employer or association in which the employer (or association) takes on the risk involved with providing coverage, instead of purchasing coverage from an insurance company.

A cap on the total lifetime benefits you may get from your insurance company.

A percentage of the cost of your care that you pay after you have met your deductible.

A type of health insurance plan that combines features of HMO and PPO plans.

A fixed fee you pay for each doctor's visit or prescription.

The maximum amount of money you will have to pay out of pocket for your care in a calendar year/plan year.

The determination that a medical treatment or service is necessary to diagnose or treat a medical condition.

The amount of money you must pay out of pocket before your insurance starts to cover the costs of your care.

The date your insurance coverage commences. In most cases, this will always be the first of a future month, although a newborn baby or newly adopted child can have coverage retroactive to the date of birth or adoption.