Glossary
Insurance words, translated.
Short, plain-language definitions of the terms you meet when comparing coverage and benefits.
Glossary terms
21 terms
- Allowance
- A set amount an employer contributes each month toward an employee’s coverage, under a reimbursement arrangement.
- Annual maximum
- The most a dental or vision plan will pay in a plan year. Costs above it are yours.
- Coinsurance
- Your percentage share of a covered bill after the deductible — for example, 20% while the plan pays 80%.
- Copay
- A fixed amount you pay for a covered service, such as $25 for a primary care visit.
- Deductible
- What you pay for covered services each year before the plan begins to share costs.
- Dependant
- A person, such as a child or spouse, who is covered under someone else’s plan.
- Formulary
- A plan’s list of covered medicines, usually grouped into tiers with different costs.
- In network
- Doctors, hospitals and pharmacies that have agreed prices with a plan. Usually the lower-cost choice.
- Metal level
- A label such as Bronze, Silver, Gold or Platinum describing how a plan splits costs between premium and care.
- Network
- The group of providers a plan works with. Staying in network typically keeps your costs lower.
- Open enrollment
- A yearly window when people can sign up for or change their health coverage.
- Out of network
- Providers without an agreement with your plan. Care may cost more, or not be covered at all.
- Out-of-pocket maximum
- The most you pay for covered care in a plan year. After you reach it, the plan pays covered costs in full.
- Plan year
- The twelve-month period a plan’s benefits, deductible and limits apply to.
- Preventive care
- Routine care such as screenings, vaccinations and check-ups, often covered at little or no cost.
- Qualifying event
- A life change — such as a move, a new child or losing other cover — that can allow changes to coverage outside open enrollment.
- Reimbursement arrangement
- An employer benefit that repays eligible coverage costs up to a set allowance, according to the employer’s policy.
- Specialist
- A doctor focused on one area of medicine, such as cardiology or dermatology. Some plans require a referral.
- Supplemental cover
- Optional insurance, such as dental, vision, accident or critical illness, added alongside major medical cover.
- Waiting period
- Time after enrollment before certain benefits, such as major dental work, become available.
Your next step
Put the words to work.
Use the guides to see these terms in a real decision.