Key Healthcare Terms and Definitions

Coinsurance - your share of certain covered services as a percentage of the service. For example if your plan's coinsurance is 10% for a covered service, and the service costs $100, you will pay $10. ($100 x 10%)

Copayment - The set amount you pay for services such as prescription drugs or a doctor's office visit.

Deductible - The amount you have to pay for services before your plan starts to pay.

Excluded Services - Services that this plan does not cover. The Health Connector - An independent public authority, also known as the Commonwealth Health Insurance Connector Authority, that acts as an insurance broker to offer private insurance to residents.

Health Savings Account (HSA) - An account for individuals and families who have health insurance policies with high deductibles. With an HSA, they can save money tax-free to use toward their medical expenses.

Minimum Creditable Coverage - Plans that cover benefits like preventive care, limit your costs, and don't limit what they'll pay for covered services.

Out-of-Pocket Expenses - The most you could pay during a coverage period (usually one year) for your share of covered services, which include copayments, deductibles, and coinsurance.

Pre-Existing Condition - A health condition or a medical problem you have before you get or change insurance plans. You cannot be denied coverage because of a pre-existing condition.

Premium - The amount you pay each month to get coverage.

Preventive Care - Care that helps you stay healthy, like flu shots and wellness visits or diabetes or cancer screenings.

Prior Authorization - When your doctor must get approval ahead of time before your health plan will cover certain services or prescriptions.

Providers - Doctors, nurses, therapists, hospitals, facilities, pharmacies, etc. who provide healthcare services.

Qualified Health Plan (QHP) - Health plans with all the benefits required by the Affordable Care Act and the Massachusetts Health Reform Act that have been approved by the Massachusetts Health Connector.

Specialist - A doctor who has extra training in an area of medicine, such as cardiology, dermatology, or pediatrics.

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