Insurance Terms you may want to know about
Insurance
An arrangement where an agency run by the government or private company agrees to pay the full or partial price of medical services. You, in exchange, pay for a monthly fee called a premium.
Premiums
Payments to the insurance company for your policy that are monthly, quarterly, semi-annually, or annually in order to receive all of the benefits that come with your plan. The amount varies by insurance company and plan chosen.
Copay
Flat-fees that you pay during a visit to a health provider, healthcare service or for prescription medications, these vary by insurance plan.
Coinsurance
This form of payment is similar to copays, but instead of a flat-fee you pay a percentage of the cost of service or prescription. The percentage varies with insurance plan.
Deductible
An amount of money you have to pay for your healthcare service, procedure or treatment before your insurance company starts covering it. For example, a $2,000 deductible means you pay up to that amount and then your insurance starts paying and you are only responsible for a copay or coinsurance for those covered services. Deductibles are normally applied to a calendar year.
Precertification
Prior authorization, prior approval, and precertification are all terms describing the decision from health insurers to either cover your service or not. This decision is on the basis of its medical necessity.
Medical Necessity
This is important when getting prior approval from your insurance. The insurance company makes the decision whether to give prior approval based on the medical necessity of the service.
Referral
Depending on your plan, your PCP may be required to write a referral or make a phone call to your insurer before you receive specialty medical services, for example psychiatry or therapy. A referral is a type of precertification.
Pre-existing condition
A preexisting condition is a condition for which you have received treatment or diagnosis before you enrolled in a new health plan.
Explanation of Benefits (EOB)
A statement from your health insurance plan describing the care your insurance policy covers.
In-Network Provider
An in-network healthcare provider is a professional you can see for as little as a copay or coinsurance. Your insurance company has a contract with an in-network healthcare provider, so they’ll charge you less for their services.
Out-of-Network Provider
An out-of-network healthcare provider is a professional that your insurance company does not have a contract with. In other words, a professional who is not in-network. These providers tend to be more expensive to see because they may require a high copay or not be covered by your insurance at all.
If you need more assistance, feel free to reach out to our Support team at support@miresource.com.
An arrangement where an agency run by the government or private company agrees to pay the full or partial price of medical services. You, in exchange, pay for a monthly fee called a premium.
Premiums
Payments to the insurance company for your policy that are monthly, quarterly, semi-annually, or annually in order to receive all of the benefits that come with your plan. The amount varies by insurance company and plan chosen.
Copay
Flat-fees that you pay during a visit to a health provider, healthcare service or for prescription medications, these vary by insurance plan.
Coinsurance
This form of payment is similar to copays, but instead of a flat-fee you pay a percentage of the cost of service or prescription. The percentage varies with insurance plan.
Deductible
An amount of money you have to pay for your healthcare service, procedure or treatment before your insurance company starts covering it. For example, a $2,000 deductible means you pay up to that amount and then your insurance starts paying and you are only responsible for a copay or coinsurance for those covered services. Deductibles are normally applied to a calendar year.
Precertification
Prior authorization, prior approval, and precertification are all terms describing the decision from health insurers to either cover your service or not. This decision is on the basis of its medical necessity.
Medical Necessity
This is important when getting prior approval from your insurance. The insurance company makes the decision whether to give prior approval based on the medical necessity of the service.
Referral
Depending on your plan, your PCP may be required to write a referral or make a phone call to your insurer before you receive specialty medical services, for example psychiatry or therapy. A referral is a type of precertification.
Pre-existing condition
A preexisting condition is a condition for which you have received treatment or diagnosis before you enrolled in a new health plan.
Explanation of Benefits (EOB)
A statement from your health insurance plan describing the care your insurance policy covers.
In-Network Provider
An in-network healthcare provider is a professional you can see for as little as a copay or coinsurance. Your insurance company has a contract with an in-network healthcare provider, so they’ll charge you less for their services.
Out-of-Network Provider
An out-of-network healthcare provider is a professional that your insurance company does not have a contract with. In other words, a professional who is not in-network. These providers tend to be more expensive to see because they may require a high copay or not be covered by your insurance at all.
If you need more assistance, feel free to reach out to our Support team at support@miresource.com.
Updated on: 07/11/2023
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