Glossary of health insurance terms

Claim
A statement that includes the health care services you’ve received and what the services cost. A claim is provided by a doctor, hospital or other health care facility and is then sent to FCHP for payment.

Coinsurance
The percentage you need to pay on all remaining eligible medical expenses after the deductible amount has been paid. For example, if your plan has an 80%/20% coinsurance rate,  FCHP will pay 80% of eligible medical expenses while you will pay the remaining 20%.

Copayment
The specified dollar amount you’re responsible to pay at the time you receive a covered service. For example, if your plan has a $10 copayment for doctor office visits, you'll pay $10 when you visit the doctor. 

Covered services
Health care services or supplies that are covered by the plan.

Deductible
A deductible is a dollar amount that must be paid before FCHP starts to pay for certain covered services. For example, if your plan has a $1,000 deductible, you'll pay the first $1,000 for certain services, and then FCHP will begin to pay for those services.

Diagnostic service
A service that is intended to diagnose, check the status of, or treat a disease or condition.

HIPAA
Health Insurance Portability and Accountability Act. This is a federal law that outlines the requirements that FCHP must fulfill in order to provide you with health insurance coverage. HIPAA also outlines strict guidelines to ensure the privacy and confidentiality of your personal health information, requiring that your personal health information be used for purposes of treatment, payment and health plan operations—and not for purposes unrelated to health care.

Network
A group of health care providers like doctors, hospitals and other health care facilities that are contracted with FCHP to provide covered services to you.

Out-of-pocket maximum
A dollar amount determined by FCHP that places a limit on the amount of expenses you pay for specific services during a particular time period, typically a year. May only apply to certain services.

Preauthorization
A guarantee from FCHP that the services you need are medically necessary and approved for coverage.

Premium
A prepaid payment made to FCHP by you and/or your employer for your health insurance coverage.

Preventive service
Any test, immunization or service geared to help screen for diseases and improve early detection when symptoms or a diagnosis are not present.

Primary care provider (PCP)
A network provider who specializes in internal medicine, family practice or pediatrics, with whom you choose to work to manage your medical care.

Provider
A doctor or other medical professional, hospital or other facility, that provides health care services to you.

Referral
A recommendation from your primary care provider that gives you the ability to see another provider for services that may be out of your PCP’s scope of practice.

Subscriber
The person whose name the health insurance policy is in.