Medical Coverage
Plain-language health-insurance terms and a practical way to understand what a plan or claim is asking you to pay.
Insurance words — plain language
Premium — what you pay to keep insurance active.
Deductible — the amount you may have to pay before insurance pays its covered share.
Copay — a set amount you pay for certain covered health services.
Coinsurance — the percentage of a covered health cost you pay.
Network — providers that have arrangements with your health plan.
Out-of-pocket maximum — the most you pay for covered in-network services during the plan period, subject to the plan's rules.
When a claim does not match what you expected
Compare the bill with the Explanation of Benefits (EOB), the plan's allowed amount, deductible, copay or coinsurance, network rules and the reason given for anything denied or left unpaid.
An EOB explains how a health claim was processed; it is not itself a medical bill.