The maximum amount on which payment is based for covered health care services. This may also be called an “eligible expense,” “payment allowance” or “negotiated rate.” If your health care provider cha [..]

The total income for a family in a calendar year (See MAGI).

A request for your health insurer or plan to review a decision or a grievance again (usually in regards to whether or not a service is covered).

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill yo [..]

The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan’s coverage documents.

An insurance program jointly funded by the state and federal governments that provides health insurance to low-income children and pregnant women in families who earn too much income to qualify for Me [..]

A request for payment that you or your health care provider submits to your health insurer after you receive items or services that you believe are covered by your plan.

The amount of money that you have to pay for a service you receive that is covered under your health plan. This amount is usually due when you receive the service. A Co-pay or co-insurance is consider [..]

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, co-insurance, and co-payments, but it doesn’t include premiums, balance bill [..]

The amount you must pay for covered health care services each year before your health insurance company will begin paying benefits. For example, if your deductible is $1,000, your plan won’t pay anyth [..]