Terms to know when shopping for medical insurance.

  1. Co-insurance – the percentage of your bill that you are responsible for, this occurs after the deductible is met but before you reach your max out of pocket.

  2. Co-pay – a flat dollar amount that you pay a provider for services, for example a $25 co-pay for a doctor’s visit.

  3. Deductible – the amount you must pay for services before your insurance starts paying.  Check your plan carefully the deductible does not apply to all services.

  4. HMO – a more restrictive but often lower cost health plan.  HMO’s save money by limiting the providers in their network and restricting coverage to only network providers except in medical emergencies.

  5. HSA – a health savings account is a way to save money, at a tax savings, for use in paying medical expenses.

  6. Maximum out of Pocket – the total including amount you could have to pay, including deductible, in a calender year for all covered services.  This does not include your premium.

  7. Network – Doctors, hospitals, pharmacies, etc… contracted to provide services for an insurance carrier at a set price.

  8. PPO – a plan offering broader coverage than an HMO, often for a higher cost.  They cover services both in and out of network, but you pay less using network providers.

  9. Provider – any medical facility or professional providing services to members.

  10. Referral – often used to control costs in an HMO a referral is a pre-authorization from your primary doctor to see a certain specialist or have tests done.

New Jersey