Health Insurance Literacy

Terminology Translator

Health insurance as its own language.  Health insurance policies vary in their cost and in the amount they pay for services you use.  Understanding how your health insurance works is your responsibility and can help you manage your choices and costs.  Here is some common terminology you may find helpful.

Premium:  The amount that must be paid for your health insurance or plan.

• If you are enrolled in an employer or Marketplace plan, you usually pay for it monthly. 
• If you are enrolled in the OSU SHBP, you pay for it each semester of the academic year.

Coinsurance:  Your share of the costs of a covered health care service. 

• Usually calculated as a percentage (for example, 10%) of the allowed amount for the service.
• Example:  if the allowed amount for a service is $200, your co-insurance payment of 10% would be $20. 

Copay:  A fixed amount you pay for a covered health care service, usually payable when you receive the service.

• The amount can vary by the type of covered health care service.
• Example:  $20 office visit copay.  Your provider may request payment at the time of your visit.

Deductible:  The amount you owe for covered health care services before your health insurance or plan begins to pay.

• Example:  if your deductible is $500, your plan won’t pay anything until you’ve met your $500 deductible.  Note, the deductible may not apply to all services.

Out-of-pocket maximum:  The most you pay during a plan period before your health insurance or plan begins to pay 100% of the allowed amount.

• This limit does not include your premium, deductible or non-covered amounts.

Network:  A network of doctors and facilities affiliated with an insurance company.

• You can lower your out-of-pocket expenses when you receive services from an in-network provider.