Below, you will see a list of terms that pertain to insurance coverage and payment for health services.

• Co-insurance: in indemnity, the monetary amount to be paid by the patient, usually expressed as a percentage of charges.

• Co-payment: in managed care, the monetary amount to be paid by the patient, usually expressed in terms of dollars.

• Deductible: the portion of medical costs to be paid by the patient before insurance benefits begin, usually expressed in dollars.

• Denial: refusal by insurer to reimburse services that have been rendered; can be for various reasons.

• Eligibility: the process of determining whether a patient qualifies for benefits, based on factors such as enrollment date, pre-existing conditions, valid referrals, etc.

• Exclusions: services that are not covered by a plan.

• Flexible Spending Arrangements (FSAs): an account that allows employees to use pre-tax dollars to pay for qualified medical expenses during the year. FSAs are usually funded through voluntary salary reduction agreements with an employer.

• Health Savings Account (HSA): a savings product that serves as an alternative to traditional health insurance. HSAs enable you to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

• Out-of-pocket: money the patient's pays toward the cost of health care services.

• Payer: the party who actually makes payment for services under the insurance coverage policy. In the majority of cases, the payer is the same as the insurer. But, as in the case of very large self-insured employers, the payer is a separate entity under contract to handle the administration of the insurance policy.

• Policyholder: purchaser of an insurance policy; in group health insurance, this is usually the employer who purchases policy coverage for its employees.

• Premium: the cost of an insurance plan shared by employer and employee.

Reference: www.apta.org