Please use this as a guide to understanding common insurance terms.
Deductible: A deductible is the amount you pay for healthcare services before your health insurance
company begins to share medical treatment costs.
Co-Pay: A co-pay is a fixed amount you pay to a healthcare provider at the time of service. The amount
can vary based on the type of service received. This is not the same as co-insurance.
Co-Insurance: A co‐insurance is a percentage of a provider’s charge you are required to pay after you’ve met
your deductible. This is a way you and your insurance provider share the cost of your medical
treatment. This is not the same as a co‐pay.
Out-of-Pocket Costs: Out-of-pocket costs are the dollar amount (usually the highest amount in the quotation) that if
met, your insurance company will pay 100% of medical treatment costs unless specifically noted
on the quotation.
Visit Maximum: Visit or Dollar maximum is the amount a health insurance is willing to pay for a covered service.
This maximum can be based on the number of visits and/or a specific dollar amount per plan
year.
Pre-Certification: Precertification and/or Authorization is a process in which the provider obtains
approval/additional approval from your health insurance before or during your treatment.
Obtaining pre‐certification for your treatment will assist you and your healthcare provider with
understanding your covered services and the number of visits covered.
Referral: A referral is your primary care provider's (PCP’s) approval for you to be treated by a specialist.
You are required to obtain a referral before you receive care.
Deductible: A deductible is the amount you pay for healthcare services before your health insurance
company begins to share medical treatment costs.
Co-Pay: A co-pay is a fixed amount you pay to a healthcare provider at the time of service. The amount
can vary based on the type of service received. This is not the same as co-insurance.
Co-Insurance: A co‐insurance is a percentage of a provider’s charge you are required to pay after you’ve met
your deductible. This is a way you and your insurance provider share the cost of your medical
treatment. This is not the same as a co‐pay.
Out-of-Pocket Costs: Out-of-pocket costs are the dollar amount (usually the highest amount in the quotation) that if
met, your insurance company will pay 100% of medical treatment costs unless specifically noted
on the quotation.
Visit Maximum: Visit or Dollar maximum is the amount a health insurance is willing to pay for a covered service.
This maximum can be based on the number of visits and/or a specific dollar amount per plan
year.
Pre-Certification: Precertification and/or Authorization is a process in which the provider obtains
approval/additional approval from your health insurance before or during your treatment.
Obtaining pre‐certification for your treatment will assist you and your healthcare provider with
understanding your covered services and the number of visits covered.
Referral: A referral is your primary care provider's (PCP’s) approval for you to be treated by a specialist.
You are required to obtain a referral before you receive care.