We know that health insurance can be confusing. This list of terms and definitions can help you as you search for a health insurance plan. If you need help signing up for the Marketplace or Medicaid, please call a HealthNet location near you or 317-957-2676.
A set percentage (for example, 20%) you have to have pay, in most cases before services are done or medicine is given.
A set dollar amount (for example, $15) you have to pay in most cases before services are done or medicine is given.
The amount you have to pay before your insurance benefits start.
Evaluation of an illness or injury so serious that you need to seek care right away to keep from getting worse.
Excluded or Non-Covered Services
Services your insurance will not pay for. You will have to pay for these services out-of-pocket.
Care in a hospital that often requires an overnight stay.
Hospital Outpatient Care
Care in a hospital that often does not require an overnight stay.
Your provider has an agreement with this insurance plan.
The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance. In-network co-insurance often costs less than out-of-network co-insurance
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance plan. In-network copayments often cost less than out-of-network copayments.
Your insurance company makes suer that the health care you get is needed. If they think that the health care you get is not needed, they will not pay for it. You will have to pay for these services out-of-pocket.
A group of doctors, hospitals, and pharmacies that sign agreements with your insurance company to give you the best health care services possible.
Your provider does not have an agreement with this insurance plan and you may have no or little coverage with the network. Out-of-Network costs are always higher.
The percent (for example 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance. Out-of-network co-insurance often costs more than in-network co-insurance.
A fixed amount (for example, $30) you pay for covered health care services from providers who do not contract with your health insurance. Out-of-network copayments often are more than in-network copayments.
The max amount the insurance company will make you pay during a calendar year. They will pay everything above that amount until that year is over.
The need for the patient or provider to get approval from the insurance company for certain services before you can be seen. If you do not follow these rules, your insurance might not pay for your bill.
The amount you pay for your health insurance monthly, quarterly, or yearly.
Drugs and medicine that by law require a prescription.
Prescription Drug Coverage
Health insurance that helps pay for prescription drugs and medicine.
Health care to prevent illness or detect illness at an early stage, when treatment is likely to work best (Pap tests, flu shots, mammograms).
Primary Care Provider
The provider you see first for most of your basic health needs.
The provider you see for special issues you may have outside of your basic health needs (heart, liver, kidneys, bones, skin, and others).