Health insurance terms at a glance

Published October 27, 2011 by
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Open enrollment season for employer-sponsored health benefits can introduce workers to a slew of unfamiliar terms. Here’s a short glossary to help decipher some of the more common words or phrases.

? Coinsurance: This is the percentage a patient pays for a medical service generally after a plan deductible is met, and it can vary by plan. Your insurer may pay 80 percent of the cost of your X-ray. You pay the remaining 20 percent.

? Co-payment: or co-pay, the flat dollar amount a patient has to contribute toward the cost of a covered medical service. An example would be the $20 charge at the doctor’s office.

? Deductible: the annual amount a patient pays out of pocket for care before insurance coverage starts. Deductibles can vary widely by plan and climb well north of $1,000.

? Flexible spending account (FSA): This lets employees set aside pre-tax wages for certain medical expenses not covered by insurance. The money must be used in the year it is set aside or it is forfeited.

? Out-of-pocket expense: the amount an employee or customer must pay toward the cost of care. This includes deductibles, co-payments or coinsurance.

? Premium: This is the cost of coverage, or the monthly bill to carry an insurance policy. In employer-sponsored coverage, the employer generally picks up most of this bill.

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