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Frequently Used Insurance Terms
Deductible: The amount of covered expense that a covered
person must incur in a calendar year and is responsible to pay
before a carrier will pay certain benefits.
Copayment: A specified dollar amount to be paid by the covered person
to a provider toward covered expenses of certain benefits.
Coinsurance: The portion of covered expenses a covered person
must pay, in addition to any copayment and deductible.
Preferred Provider Organization (PPO): A network of
health care providers contracted with the carrier to provide services
at a discounted rate.
In-Network Provider: A hospital, health care treatment facility,
health care practitioner or other provider who is designated as such and has
signed an agreement with the carrier to provide services to covered persons.
Out-of-Network Provider: A hospital, health care treatment facility,
healthcare practitioner or other provider who has not signed an agreement with t
he carrier or who has not been designated by the carrier to provide services to a
covered persons.
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