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Insurance Terminology

Deductible – the amount you owe for health care services before your health insurance plan begins to pay.
You may choose a higher deductible to lower your monthly premiums.

Out of Pocket Maximum – the most you pay during a policy period before your health insurance plan
begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or
health care your health insurance plan does not cover.

Coinsurance – your share of the costs of a covered health care service, calculated as a percent of the
allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health
insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance
payment of 20% would be $20.

Copay – a fixed amount (for example, $15) you pay for a covered health care service, usually when you
receive the service. The amount can vary by the type of covered health care service.

Primary Care Physician (PCP) – a physician who directly provides or coordinates a range of health
care services for a patient. If you enroll in an HMO plan, you must be assigned a PCP.

Health Maintenance Organization (HMO) – a type of health insurance plan that usually limits
coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-
network care except in an emergency. An HMO may require you to live or work in its service area to be
eligible for coverage.

Preferred Provider Organization (PPO) - a type of health plan that contracts with medical
providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use
providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the
network for an additional cost.

The Master’s University & Seminary Page 4
2021 Employee Benefits Brochure