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Here is a list of commonly used healthcare terms and what they mean.

Allowed amount: The most a plan will pay for a covered health service.

Balance billing: The amount you must pay between what a provider charges for a service and the allowed amount your insurance plan pays. If the provider charges $100, and your allowed amount is $70, you  are balance billed (you must pay) $30.

Benefits: Healthcare items or services covered under your plan.

Coinsurance: Once you’ve paid your deductible, you’ll pay part of the bill for your care, and Blue Cross will pay part of it. For example, you might pay 20% coinsurance, and your plan will pay 80% (depending on your plan).

Copay: A fixed dollar amount that you pay when you visit a medical professional.

Deductible: What you pay before your health insurance begins to pay for your medical service.

Exclusions: Amounts not covered under your current health plan.

Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.

Health Savings Account: A type of savings account that allows you to set aside money before taxes to pay for qualified medical expenses.

Network: A doctor, hospital or other medical facilities that provide healthcare services to your health insurer or plan. For example, if you have an HSA plan, you would be in the Preferred Care (PPO) network and would get care from doctors or hospitals in that network.

Out-of-Pocket costs: Your expenses for healthcare that are not paid for by your insurance plan. Out-of-pocket costs include deductibles, coinsurance and copayments for covered services and all costs for services that are not covered by your insurance plan.


Source: healthcare.gov