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The amount you pay for your health insurance every month. For example, if your premium is $300, you must pay this amount each month to maintain coverage.$

A health problem you had before the date that new health coverage starts. An example is diabetes. Health insurers cannot refuse coverage or charge more for pre-existing conditions.

The extent of protection provided by an insurance policy. For example, a health insurance plan might cover services like doctor's visits, prescriptions, and surgeries.

A health care practitioner who sees people that have common medical problems. This person is most often a doctor. For example, you may visit your PCP for an annual check-up or when you're sick.

The time period during which individuals can purchase health insurance or switch plans. For example, an open enrollment period might run from November 1 to December 15.

A statement from your health insurance company detailing what costs it will cover for medical care or products you’ve received. For example, after a doctor's visit, you might receive an EOB showing the amount billed, the payment amount by the insurer, and what you owe.

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. For example, if a medication is on your plan's formulary, it is covered.

A provider with advanced training and knowledge in a specific area of medicine. For example, a cardiologist is a specialist that you might visit if you have heart-related issues.

The person who owns the insurance policy. For example, if you purchase health insurance for yourself, you are the policyholder.

Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. For example, annual physical exams and vaccinations are preventive services.

The time period after the due date for a premium during which the policy remains in force without penalty. For example, a 30-day grace period allows you to pay the premium up to 30 days after the due date without losing your coverage.

A request for payment that you or your health care provider submits to your health insurer when you receive items or services you think are covered. For example, after a hospital stay, the hospital may submit a claim to your insurance for the services provided.

The facilities, providers, and suppliers your health insurer has contracts with to provide health care services. For example, if your doctor is 'in-network', your costs will be lower compared to 'out-of-network' providers.

The maximum amount an insurance company will pay for claims over the life of a policy. For example, an insurance policy may have a $1 million lifetime limit.$

Care for an illness or injury that is not a life-threatening emergency but requires attention within 24 hours. For example, a visit to an urgent care clinic for a sprained ankle.

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period. For example, if you get married, you can add your spouse to your insurance.

A fixed amount ($for example) you pay for a covered health care service after you've paid your deductible. For instance, a$25 co-pay for a doctor's visit would apply after your deductible is met.

A person who is entitled to receive benefits from an insurance policy. For example, your spouse can be a beneficiary on your health insurance policy.

A system to eliminate insurance duplication when you are covered by more than one health plan. This determines which plan pays first. For instance, if you have two health insurances, COB decides which one is the primary payer for a claim.

Specific conditions or circumstances for which the insurance policy will not provide coverage. For example, some health insurance policies exclude coverage for elective cosmetic surgery.

The process by which an insurer evaluates the risk of insuring a home, car, or individual. In health insurance, this can determine premiums or coverage. For example, an insurer might use medical history to decide whether to offer coverage.

The amount you must pay out of pocket for services before the insurance company starts to pay its share. For example, with a $1,000 deductible, you pay the first$1,000 of covered services yourself.

The most you have to pay for covered services in a year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. Example: An out-of-pocket maximum of $6,000.$

A decision by your health insurer that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. For example, getting insurer approval for a special procedure before it is performed.