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Tiger and Tiger Dry Goods | Medical Insurance Vocabulary Popular Science

Medical Insurance Vocabulary Popular Science

Health insurance bills and rules in the United States can be difficult to understand for anyone, let alone international students and their families. Following is a glossary of insurance terms designed to aid in your search for, and comprehension of, the health insurance plan that best suits your needs and budget.

Deductible

This refers to the amount due from the policyholder before the insurance company will pay out. When an insured person incurs medical expenses that total more than the policy’s deductible amount, such as $500 in a given year, the insurance company begins to pay a portion of those expenses.

Something to keep in mind is that despite the low appearance of some insurance premiums, they may actually have quite hefty deductibles. A greater deductible means you’ll have to pay out of pocket before your health insurance kicks in.

Paid in Part of the Initial Expenses of Registration

That is, just like the domestic registration cost, the insured must pay a set amount every time they see a doctor. The one-time cost to enroll in a medical school might vary widely.

Ratio of payments to coinsurance

That is, the portion of each medical visit that the policyholder will be responsible for paying after the deductible but before the annual maximum payment is reached. In this case, the insurance company will cover the difference. After meeting the deductible, the policyholder would be responsible for only 20% of the total medical expense with the insurance company covering the other 80%.

Highest amount a patient would have to pay out of pocket

In other words, it is the most anyone will have to pay during their enrollment period (usually one year). Prior to reaching this limit, the insurance company and the insured both share the cost of covered medical care. In the event that an insured person’s out-of-pocket costs for medical care reach the policy maximum, the insurance company will assume full responsibility for any further costs.

Participating Doctor’s Office, Clinic, or Drugstore

In particular, the medical professionals—doctors, hospitals, and pharmacies—that make up an insurance provider’s network. Participating medical professionals and facilities will bill patients in accordance with the payment guidelines established by the insurance plan. In most cases, insurance companies would advise their policyholders to use in-network providers whenever possible.

Doctors, Hospitals, and Pharmacies Outside of the Plan’s Network

That is, hospitals and clinics not affiliated with the insurance company. Those medical facilities and practitioners that have not reached an agreement with insurance companies regarding payment, coverage, etc.

Medical costs will vary greatly depending on whether you see a doctor or go to a hospital that is part of your insurance network or not. When seeing a doctor or hospital that is not part of your insurance network, you should expect to pay a substantially greater percentage of your treatment costs out of pocket, as well as a higher fixed registration fee.

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