A comprehensive arrangement, typically provided by insurance companies or employers, that covers a range of medical expenses and services for individuals or groups. Health plans may include coverage for hospitalization, doctor visits, prescription drugs, preventive care, and other healthcare services.
The amount of money paid by an individual or employer to an insurance company or health plan provider in exchange for coverage. Premiums are usually paid on a monthly or yearly basis.
The amount of money an individual must pay out-of-pocket for covered healthcare services before the insurance company or health plan begins to pay. Deductibles vary depending on the specific health plan and can range from hundreds to thousands of dollars.
The percentage of covered healthcare costs that an individual is responsible for paying after the deductible has been met. For example, if a health plan has a 20% coinsurance rate for hospitalization, the insured individual would pay 20% of the covered expenses, while the insurance company would pay the remaining 80%.
The maximum amount of money an individual is required to pay for covered healthcare services during a specified period, typically one year. Once the out-of-pocket maximum is reached, the health plan typically covers 100% of covered expenses.
A group of healthcare providers, including doctors, hospitals, and other facilities, that have contracted with an insurance company or health plan to provide services to its members at discounted rates. Health plans often require members to use providers within the network to receive the highest level of coverage.
A process by which an insurance company or health plan must approve certain healthcare services or treatments before they are provided to ensure they meet medical necessity criteria. Failure to obtain preauthorization for certain services may result in reduced coverage or denial of payment.
A list of prescription drugs that are covered by a health plan and their associated costs. Health plans typically categorize drugs into different tiers based on cost and may require higher co-payments or coinsurance for drugs in higher tiers.
A tax-advantaged savings account that individuals can use to pay for qualified medical expenses. HSAs are typically paired with high-deductible health plans and allow individuals to save money on a pre-tax basis to cover out-of-pocket healthcare costs.