A claim is a payment request sent by your healthcare provider to your health insurance company. It is typically in the form of an itemized bill that lists all the medical services provided to you. Claim dates can range from one day of service at your doctor’s office to an extended hospital stay.

COBRA is a health insurance program that offers eligible employees and their dependents extended health insurance coverage for the plan they’re on, in the event that they lose their job or their hours are reduced.

It stands for the Consolidated Omnibus Budget Reconciliation Act of 1985, which is the law that first introduced COBRA insurance.

This is the percentage you’ll pay for covered health services after you’ve met your annual deductible. Many plans offer 80/20 coinsurance, covering 80% of the cost of a service. That means you’ll pay 20%. So if you visit the doctor and it costs $100, you’ll pay $20.

More commonly referred to as a copay, this is a set amount you’ll pay for covered health services once you’ve met your deductible. Copays can vary depending on whether it’s for a medication, a visit to the doctor, or a lab test. If your insurance plan states that your copay for visits to the doctor is $20, that’s how much you’ll pay for that care.

The amount you’ll pay out of pocket for covered health services before your insurance plan starts to pay.

This is a document you receive from your health plan after using your medical insurance. It breaks down how much you and your health plan are each responsible for paying. An EOB is not a bill. It gives you a heads-up about what to expect when the actual bill arrives from your healthcare provider. It includes payment details, benefits, discounts, and denial reasons. 

Generic drugs have the same active ingredients, quality, and effect as brand-name drugs but are far less expensive. The FDA also checks them to ensure they’re safe and effective. However, not all drugs have a generic version.

This refers to care or providers who are part of your insurance plan’s contracted network. Services from in-network providers typically cost less compared to services from out-of-network providers. 

Inpatient care requires a hospital stay and continuous supervision by a healthcare provider. This could be for care after a minor surgery or for a serious ongoing health condition.

The providers, hospitals, and suppliers your health insurer has contracted with to deliver healthcare services.

This refers to care or providers who are not part of your insurance plan’s contracted network.

Out-of-pocket costs can include deductibles, coinsurance, and copays that are not reimbursed by your health insurance plan.

This type of care does not require an overnight stay in the hospital or healthcare facility.  It’s typically a service or procedure you can have within a few hours and then return home the same day. For instance, once you receive an X-ray, MRI, or blood work at a laboratory or diagnostic center, you are free to leave the facility.

A premium is the recurring payment to your insurance company that keeps your health insurance active. It is typically paid monthly by you and your employer. But payments can also be made quarterly or yearly. The premium may include certain benefits, such as free annual checkups. But it does not cover all your healthcare costs, such as deductibles, copayments, and coinsurance.

These are routine health assessments to identify or prevent potential health problems. They often include screenings to detect hidden health issues, lab work, and checkups with your doctor. 

Prior authorization is approval from your health plan before you receive certain medications, tests, or treatments. This is sometimes known as preauthorization. Your health insurer determines if the services are medically necessary, except during an emergency. Depending on your benefits, some services may not be covered without pre-approval.

The SBC is a document that provides essential information about a health insurance plan, including costs, benefits, covered services, and exclusions.