Health Insurance Terms to Know

Health Insurance Terms California

When you are new to health insurance, understanding the commonly used terms of a standard health insurance policy can ensure you make the right decision and get the appropriate level of coverage for your needs. American Tri-Star Insurance, a trusted San Diego health insurance agency, shares the top terms to know:

  • Allowable charge

    The dollar amount considered by the insurance agency to be a reasonable charge for the medical supplies or services provided depending on rates in the area where you live.  Also known as maximum allowable, usual, customary, and reasonable (UCR), or allowed amount.

  • Benefit

    The amount of money paid by the insurance agency for the medical supplies and services.

  • Claim

    A request for the coverage of medical services from the health plan member or their health care provider.

  • Co-payment

    A fixed amount the plan member pays to help share the cost at the time of service.

  • Deductible

    The amount of money the plan member pays out of pocket for health services before the insurance starts paying for them.

  • Dependent

    A spouse or child of the plan member also covered by the insurance.

  • Drug Formulary

    A list of medications and medical supplies that are covered by the insurance.

  • Exclusion

    Also known as a limitation, is any condition, treatment, or situation that the insurance will not cover.

  • Health Maintenance Organizations

    Also known as an HMO, is a managed care plan that provides comprehensive services for plan members in a certain geographic area. These plans may require a referral from a primary care physician for a plan member to see a specialist.

  • Preferred Provider Organization

    Also known as PPO, is a plan that allows the plan member to visit any health care provider from a preferred network of hospitals and physicians.

Finding the right health insurance policy can provide you with peace of mind. If you’re looking for more information about the policy that’s best for you, call American Tri-Star insurance at (619) 325-0326 and speak with an expert insurance agent.