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Health insurance terms and definitions
Health insurance terms and definitions
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Written by Jess
Updated over 3 months ago

Here are definitions to some of the most common health insurance terms associated with health insurance plans. For more terms, see our health guide.

Premium

A premium is a monthly payment to your provider for health insurance. Just like rent or a streaming service, you keep your plan active by paying for it each month.

Deductible

Your deductible is the amount you pay for healthcare before your insurance coverage kicks in. Some basic services, like your flu shot, are covered even before you hit your deductible.

Copay

A copay is a fixed amount you pay for a covered service (for example, an x-ray) once you’ve already hit your deductible. You won’t have to pay this anymore once you hit your out-of-pocket maximum.

Coinsurance

It’s a fixed percentage of your medical bill that you pay for a covered service once you’ve already hit your deductible. You won’t have to pay this anymore once you hit your out-of-pocket maximum.

Out-of-pocket maximum/limit

Your out-of-pocket maximum is the most that you'll have to pay for covered medical services in a given year. You can think of it as an annual limit on your healthcare costs. Once you reach that limit (via deductibles, copayments, and coinsurance), your plan pays for all covered medical expenses for the rest of the year.

Your monthly premiums do not count towards your out-of-pocket maximum.

In network vs. out-of-network

In-network care is almost always cheaper, because your carrier will have made a deal with your provider on rates. Out-of-network care is sometimes covered, depending on the plan you pick, but it’s almost always more expensive, and often has a separate deductible you have to hit before it will be covered.

Essential Health Benefits

All plans available through Catch are ACA-compliant. That means they cover all of the following: 

  • Ambulatory patient services (visits to doctors and other healthcare professionals and outpatient hospital care)

  • Emergency services

  • Hospitalization

  • Maternity and newborn care

  • Mental health and substance use disorder services, including behavioral health treatment

  • Prescription drugs

  • Rehabilitative and habilitative services and devices

  • Laboratory services

  • Preventive and wellness services and chronic disease management

  • Pediatric services, including oral and vision care

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