The maximum amount an individual or family is required to pay for covered healthcare expenses during a specific period, beyond which the insurance plan covers 100% of the costs.
The initial amount an individual must pay for covered healthcare services before the insurance plan begins to contribute. This is separate from the out-of-pocket limit.
A fixed amount that a patient pays for covered healthcare services at the time of service, often required for both in-network and out-of-network care.
A cost-sharing arrangement in health insurance where the policyholder pays a percentage of the covered healthcare expenses after meeting the deductible, until reaching the out-of-pocket limit.
A list of healthcare providers, including doctors, hospitals, and clinics, that have contractual agreements with a specific insurance plan to provide services at negotiated rates.
Healthcare providers or facilities that have a contractual agreement with an individual’s insurance plan, typically resulting in lower out-of-pocket costs for the insured.
Healthcare providers or facilities that do not have a contractual agreement with an individual’s insurance plan. Seeking services from these providers may result in higher out-of-pocket costs.
A statement from the insurance company explaining how a claim was processed, including details on what the insurance covered, what the patient owes, and any remaining balance.
The yearly process during which individuals review and update their health insurance coverage, including any changes to premiums, deductibles, and out-of-pocket limits.
A tax-advantaged savings account that allows individuals to set aside funds for qualified medical expenses, often used in conjunction with high-deductible health plans.
A tax-advantaged savings account that allows individuals to set aside pre-tax dollars for qualified medical expenses, often used in conjunction with traditional health insurance plans.