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Health Insurance Dictionary

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Health Insurance Dictionary

Everybody needs a health insurance dictionary. A hot topic like health insurance has complexities that leave us wondering where to begin our journey to the most divine health insurance plan. There is nothing worse than having a conversation with someone and having no clue what they’re talking about. Oh, wait a second! There is something worse. Talking to an insurance agent about YOUR healthcare plan and getting lost in the health insurance jargon.

So here at Smallwood and Small we don’t want to confuse you. We want to improve you! We have broken down a list of what’s what in the health insurance dictionary. Here is a rundown of the most common jargon.

Below are terms relating to health insurance payments.

Actuarial Value- This is the percentage of costs your plan will cover on average. So, if a plan has an actuarial value of 60% than you would be in charge of covering 40% of the costs of all covered benefits.

Affordable Coverage- When you are on an employer’s health insurance plan that is considered affordable coverage. This coverage ties into the premium tax credit. Bare in mind, coverage is only considered affordable if the employee’s shared yearly premium for the lowest priced self-only plan is no greater than 9.5% of annual household income.

Coinsurance- This is the amount you pay for a covered health care service. Your dollar amount is calculated as a percent (for our purposes, we’ll say 10%). YOU pay the coinsurance amount plus any deductibles you may have. For instance, if an office visit is $100 and you’ve met your deductible, your coinsurance payment of 10% would be $10. Your health insurance/ plan covers the rest.

Copayment- A fixed amount you will pay for a covered health care service. Co-pays are commonly due at the time of service. Your copayment is not always the same amount. It depends on the type of covered health care service.

Claim- A bill that your doctor or yourself submits to your health insurance company when you get items or services that you think are covered.

Deductible- The amount you owe for services before your health insurance/plan begins to pay.

The following terms are different types of coverage for health insurance plans.

Creditable Coverage- The following types of insurance/plan are considered creditable coverage: student health insurance; individual health insurance; a group health plan; Medicare; Medicaid; CHAMPUS and TRICARE; the Federal Employees Health Benefits Program; Indian Health Service, the Peace Corps; or CHIP.

Dental Coverage- Benefits that pay for basic dental services like teeth cleanings, X-rays, and fillings.

Dependent Coverage- Insurance coverage for a policyholder’s family members.

Prescription Drug Coverage- Health insurance/plan that helps foot the bill for prescription medications.

State Continuation Coverage- Group health insurance policies for employers with fewer than 20 employees. This is a state-based requirement.

 We’ve broken down some of the most common terms that are dropped in our office. If you would like to peruse a more extensive health insurance dictionary, click here. Be sure to call us at 304-263-3361 or visit our website to learn more about our health insurance plans!

Photo Credit: “Yellowed pages from a dictionary” by Horia Varlan. Licensed under CC BY 2.0


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