Glossary


Just Plain Clear® Glossary

Visit justplainclear.com—an online glossary with thousands of health care-related terms—to make more informed health decisions. Available in English, Spanish and Portuguese.

Common Benefit Terms

Term Description
Co-insurance Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest.
Co-pay A fixed amount you pay for a covered health care service (for example, a doctor's visit), usually when you receive the service. The amount can vary by the type of covered health care service.
Co-share See "premium".
Deductible The amount you owe for health care services before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Flexible spending account (FSA) An FSA allows an employee to set aside a portion of earnings on a pre-tax basis to pay for qualified expenses (medical, dental, vision, and day care) incurred during the plan year. Contribution limits apply. Unlike an HSA, FSA contributions can only be made during open enrollment or a status change, and FSA account balances are subject to a "use it or lose it" rule.
Health reimbursement arrangement (HRA) An HRA provides eligible retirees reimbursements for qualified medical expenses in the form of State subsidies.
Health savings account (HSA) An HSA—typically offered in a high deductible health plan (HDHP)—allows an employee to set aside a portion of earnings on a pre-tax basis to pay for qualified expenses. Contribution limits apply. Unlike an FSA, HSA contributions can be changed at any time during the year, and HSA account balances are not subject to a "use it or lose it" rule.
Out-of-pocket maximum The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health plan doesn’t cover. Check with your health insurance provider on whether your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses count toward this limit.
Premium ("co-share") The amount that must be paid for your health insurance by you and/or your employer. The amount that you are responsible for is called a "co-share", and it is typically deducted from your paychecks.