Popular Health Insurance Terms You Need To Understand

by Anil Kumar ~ July 31st 2018

Popular Health Insurance Terms You Need To Understand Health insurance plans have been saving people’s lives and helping to keep them well for decades. Insurance providers are offering a wide range of plans to cater the specific requirements of people. However, there are people who aren’t that familiar with health cover plans and different terms associated with the same. This creates a lot of confusion while buying a plan and most of the time they end up buying a plan that isn’t made for them. In this blog, you will come to understand the various popular health insurance terms that you might have been hearing often.

Allowed Charge

This is a discount fee for which the doctors, hospitals or healthcare providers provide treatment to the policyholder. The doctors, hospitals or health care providers in the same network with the insurer agree to provide their services at a discounted rate and the insured receive the treatment at cheaper costs.

Allowed Maximum Benefit

Some insurer set a limit on the maximum amount they will be paying every year. If your monthly treatment expense tops that amount, you are supposed to take care of the difference. However, most of the providers do not set a limit on maximum annual expenses.

Catastrophic Coverage

This is a cover designed to afford expensive services such as admission into the hospital and surgeries and rehabilitation services. Usually, these are cheap health insurance plans offered at very affordable monthly premiums.


These are the services offered to the insured mentioned in an insurance agreement. The benefits vary depending on the providers as well as the plans offered.


A health care plan where you must share a portion of treatment expenses with the provider. If your provider offers a plan for 20 percent contribution, this means they will pay for the 80 percent of the expenses and you have to take care of the rest.


This is a request for payment to the insurance provider when the policyholder falls ill or meets an accident. If you are the policyholder, you can submit this request or your doctor or the health care provider can submit the request on your behalf.


This is known as a fixed amount that the insured needs to pay every they see a doctor. Usually, insurance providers offer a $20 copayment plan to cover your expenses of visiting a physician.

Cost Sharing

The arrangement which defines how the health insurance plans will work where both insured and insurer are supposed to share the cost treatment in case of illness or an injury. Copay, coinsurance, and deductibles are some known examples of cost sharing.


This is the amount that is supposed to be paid by the policyholder to qualify for receiving a claim. For example, if the deductible for your health insurance plan is $1000, you are supposed to pay that before the insurance provider process your claim.

Essential Health Benefits

The Affordable Care Act has emphasized on providing certain health benefits to every American in need. These benefits include but aren’t limited to hospitalization, outpatient surgery, maternity and newborn care, emergency services, rehabilitative and habilitative services and devices, laboratory services, mental health and substance abuse services, chronic disease management, pediatric services including vision and oral care as well as preventive and wellness services. However, the list of these services may vary little depending on the state providing the health benefits.

Health Savings Account

An option that enables you to keep some amount aside in your existing health care plan. This amount may vary from $1,000 to $5,000 and are more suitable for buyers with a high deductible plan. These are the plans where the insured has to pay some certain amount to receive the claim after falling ill or meeting an injury.


These are the medical conditions excluded in an insurance plan. This means you may not receive a cover for the conditions mentioned in the insurance policy. Usually, the insurance providers don’t provider a cover, suicidal attempts, criminal violence, drug or alcohol consumption, involving in war-like activities and participating in dangerous adventurous sports.

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