Glossary of Terms

Common health insurance terms

The health insurance industry uses many specific terms and definitions, and it’s important to understand what they mean.

If you do not understand the language in your health insurance documents, contact your insurance provider for help.

Claim: A request from a provider for payment for benefits received or services rendered.

Have questions? IU Student Health Insurance Coordinators can help explain the IU plan, contact them at (812) 856-4650 or studenhc@iu.edu. You can also contact your insurance provider directly for help.

Coinsurance: The amount you are required to pay for medical care in a fee-for-service plan after you have met your deductible. The coinsurance rate is usually expressed as a percentage. For example, if the insurance company pays 80 percent of the claim, you pay 20 percent.

Copay: A flat fee for every time you receive a medical service (for example, $25 for every visit to the doctor). The insurance company pays the rest after you pay the deductible.

Deductible: The amount of money you must pay each year to cover your medical care expenses before your insurance policy starts paying.

Exclusions: Specific conditions or circumstances for which the policy will not provide benefits.

Inpatient: Service provided after you are admitted to the hospital. Inpatient stays are those lasting 24 hours or longer.

Maternity care: Services that generally include prenatal care, normal childbirth/delivery services, and routine newborn nursery care.

Medical evacuation: When you must return to your home country or you are evacuated to an appropriate medical facility for medical treatment due to an emergency medical situation.

Network: The select doctors, clinics, hospitals, and other medical providers your insurance company contracts with to provide health care to its members at negotiated rates.

Out-of-pocket maximum: The most money you will be required to pay each year for deductibles and coinsurance. This is a stated dollar amount set by the insurance company, in addition to regular premiums.

Outpatient: Care provided in a clinic, emergency room, hospital or non-hospital surgical center, without admitting the patient.

Preexisting condition: A health problem that existed before the date your insurance became effective.

Preferred provider: A doctor who is referred by your insurance company. When you use the doctors and hospitals that are preferred providers, a larger part of your medical bills are covered. You can use other doctors, but at a higher cost.

Preauthorization/Precertification: The process of receiving approval for some health care, such as hospitalization, outpatient surgery or prescription drugs, before it can be covered. Through this process, eligibility and determination of coverage can be confirmed and communicated before you receive treatment or services.

Premium: The fee or charges incurred to receive coverage by an insurance company.

Prescription: A doctor’s order for a prescription drug, which is filled at a pharmacy.

Preventive care: Programs or services, such as annual physical exams and immunizations, that can help maintain good health or are meant to detect early signs of health problems or disease, such as mammograms and cancer screenings.

Primary care doctor: This is usually your first contact for health care—often a family physician—although some women use their gynecologist. A primary care doctor monitors your health and diagnoses, treats minor health problems, and refers you to specialists if you need another level of care.

Provider: Any person (doctor, nurse, dentist) or institution (hospital, clinic) that provides medical care.

Repatriation: In case of death, this covers the cost of returning the covered person’s body to the home country.

Urgent care: Services received for an unexpected illness or injury that is not life-threatening but requires immediate outpatient medical care and cannot be postponed. An urgent situation requires prompt medical attention to avoid complications, unnecessary suffering, or severe pain. Find an urgent care provider near campus.

Usual, customary, and reasonable: The amount charged or the amount determined to be the reasonable charge, whichever is less, for a particular covered service in the geographical area where it is performed.

Glossary of Terms

Common health insurance terms

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