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Understanding Health Insurance Terms

Understanding Health Insurance Terms

When shopping for a health insurance policy, one must be familiar with some of the

terms used to understand the full details of the health insurance policy. The terms used in a health insurance policy can be confusing but are necessary to help identify coverage and limitations as well as aid in choosing doctors and facilities that will maximize health care savings. This article will aid in clarifying some of the commonly used terms and simplify them to make them easier to understand.

One of the most confusing terms used in health care policies is in-network and out-of-network. Understanding these terms is important because knowing which doctors and facilities is in-network will maximize health care savings. The in-network term identifies doctors and facilities that are partners with the insurance company. Partnered doctors and facilities often give the insurance companies significant discounts on health care and procedures which then get passed along to the policy holders.

Out-of-network doctors and facilities are not partnered with the insurance company and therefore do not offer the same savings as in-network partners. This does not necessarily mean there are not discounts applied to the health care costs but when compared to in-network partners the discounts are not as substantial. Because of this, many insurance policies put more of the health care cost burden on the policy holder by limiting the coverage amount. To maximize health care savings, it is always best to use in-network partners when possible.

Another important term to be familiar with is out-of-pocket expenses. While this may seem to be self-explanatory many are quite confused by it as the less expensive policies have a higher out-of-pocket expense limit. Most health insurance policies are not complete coverage for any and all medical expenses. In addition to health insurance premiums, partial health care cost burden still lies on the policy holder which is what the out-of-pocket expense limit clearly defines. This is the maximum amount the policy holder will have to pay out-of-pocket before the insurance company will cover costs one hundred percent.Understanding Health Insurance Terms


Lifetime maximum benefit is another term that many should become familiar with. This term identifies the maximum amount of benefits that will be paid by the insurance company over an individual's lifetime. Once this limit has been reached the policy is considered fulfilled and all benefits under the policy will cease. This is extremely important to be aware of in case of an illness or injury that requires extended medical treatment which can possibly lead to the maximum benefit to be reached.

These terms are only a small handful of the common terms that will be encountered when shopping for a health insurance policy. There are many other terms used in health care policies that may not be familiar or are confusing to understand. While articles such as this one can help individuals understand some of the terms it is also a good idea to seek the advice of an attorney to get full details and understanding.

by: Casey Trillbar
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