Covered Lives

The total number of individuals enrolled in a healthcare plan, including both individuals and their dependents, who are eligible to receive benefits under the plan.

 

Enrollment

The process of individuals signing up for healthcare coverage, either through employer-sponsored plans, government programs like Medicaid or Medicare, or private insurance exchanges.

 

Beneficiary

An individual who is covered by a healthcare plan and is entitled to receive benefits for medical services covered by the plan.

 

Premium

The amount of money paid by the policyholder or employer to the insurance company to maintain healthcare coverage for a specified period, typically monthly.

 

Deductible

The amount of money that an individual must pay out of pocket for covered healthcare services before the insurance company begins to pay for services.

 

Network

The group of healthcare providers, including doctors, hospitals, and clinics, that have agreed to provide services to individuals covered by a specific healthcare plan at negotiated rates.

 

Preventive Services

Healthcare services that aim to prevent illness or detect conditions early when treatment is most effective, often covered at little to no cost for individuals with healthcare coverage.

 

Out-of-Pocket Maximum

The maximum amount of money that an individual is required to pay for covered healthcare services during a specified period, after which the insurance company covers 100% of additional costs.