Health insurance terms to know

7 important health insurance terms

Deductible
A set dollar amount you pay towards when you get care for most covered services. When you meet your deductible, it goes away until the start of the next plan year.

Coinsurance
The cost for care that Blue Cross of Idaho splits with you. For example, if we pay 70% of the cost of a bill, you would pay 30%.

Copayment
A set amount you pay directly to a doctor or hospital for care.

Out-of-pocket maximum
The maximum amount that you pay for healthcare each year. Your deductible, copayments and coinsurance all contribute toward your out-of-pocket maximum each year.

Provider
A doctor, specialist, nurse practitioner or physician assistant who gives you care, or a hospital, pharmacy or clinic where you get care.

In network
The group of doctors, hospitals and clinics that Blue Cross of Idaho contracts with who’ve agreed to see our members for a lower cost. You get the most out of your benefits when you see in-network providers.

Out of network
The providers who have not contracted with Blue Cross of Idaho. You’ll pay more when you see an out-of-network provider.

Glossary of Terms

Posted: June 28, 2021