Insurance Terms you may want to know about

Signing with an insurance company and plan can be stressful! That’s why we at MiResource want to make sure you understand exactly what you are getting yourself into. Make sure to look for these terms when you start looking into insurance options; we encourage you to speak with your provider if there is something you need additional clarification on. 

• Insurance
• • Government or private agency agrees to pay part or all of a medical service
  • You pay a monthly fee called a premium

• Premiums
• • Payments to the insurance company to get all benefits in your insurance plan
  • Can be monthly, quarterly, semi-annually, or annually 
  • Can vary by company and plan chosen

• Copay
• • Flat-fees you pay during a visit to a health provider, healthcare service, or for prescription medications
  • Can vary by insurance plan

• Coinsurance
• • You pay a percentage of the cost of service or prescription
  • Varies with insurance plan

• Deductible
• • Amount you must pay for your service, procedure, or treatment before the company covers it
  • Normally applied to a calendar year

• Precertification
• • Decision from health insurers to cover your service or not
  • Decision based on medical necessity
  • Also known as prior authorization and prior approval

• Medical necessity
• • Decision by insurance company to give prior approval based on necessity of service

• Referral 
• • PCP may be required to write a referral or make a phone call before you can receive specialty medical services
  • Is a type of precertification

• Pre-existing condition
• • Condition for which you have received treatment or diagnosis before you enrolled in a new health plan

• Explanation of Benefits (EOB)
• • Statement from your health insurance plan describing the care your insurance policy covers

• In-Network Provider
• • A professional you can see for as little as a copay or coinsurance
  • Charge less for services

• Out-of-Network Provider
• • A professional your insurance company does not have a contract with
  • Professional that is not in-network
  • Tend to be more expensive because they are not covered by your insurance fully (if at all) and may require a high copay

Hopefully now you understand a little more about your insurance plan!

For more assistance, please feel free to reach out to our Support Team at support@miresource.com. 

Updated on: 07/10/2025