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Deductible

The amount of money you must pay for covered health care services before your insurance plan starts to pay.

Coinsurance

Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) after you've met your deductible.

Copayment

A fixed amount (for example, $20) you pay for a covered health care service after you've met your deductible.

Out-of-Pocket Limit

The maximum amount you will have to pay for covered health services in a plan year. Once you reach this limit, your insurance plan pays 100% of the costs.

High-Deductible Health Plan (HDHP)

A health insurance plan with a higher deductible than a traditional insurance plan. They typically have lower monthly premiums and can be paired with a Health Savings Account (HSA).

Utilization Management

Techniques used by health plans to control healthcare costs and improve quality by managing access to services, such as requiring prior authorization or step therapy before a treatment is covered.

Specialty Drugs

High-cost prescription medications used to treat complex or rare conditions, often requiring special handling, administration, or monitoring.