Finding the right medical insurance for yourself can be a daunting and complex task. Every insurance company has different models and unique features. In order to get the best coverage for the best value, you need to assess your current situation and know the jargon of the industry. It will also help to understand what the plans truly offers.

Health plan documents are full of technical jargon, but you don't have to be intimidated. Here are some helpful definitions you might see:

Cap: This is the maximum amount of the insurance company will pay over a lifetime.

Claim form: In order to receive payment for services rendered, you or your health care provider must complete this form and send it to the insurance company.

Coinsurance: This is the percentage of the health care bill you have to pay after the deductible.

Co-payment: This is an out of pocket charge for a visit to the doctor or hospital.

Covered expenses: These expenses will be paid for by the insurance company. Remember, not all expenses are covered by the health plan.

Customary fee: This is the amount the health care provider charges for a service. It can also be called a usual and customary fee.

Deductible: This is an expense that you need to pay before the insurance plan begins paying.

Exclusion: Services that are not covered by the insurance company.

In Network: In order to avoid higher costs you can choose from a list of health providers selected by your insurance company.

Maximum out of pocket expenses: This is the most you will ever have to pay during one year of deductibles and coinsurance.

Out of network: These are licensed health care providers who are not on the in network list.

Premium: This is the annual cost of the insurance coverage.


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