Definition of Important Medical Insurance Terminology

Today is the first day of 2023, and iCare would like to wish everyone a happy new year! At the same time, I hope all of you, whether you are in your hometown or a foreign country, will take care of your health and spend the year in a healthy way! Today's article introduces you to some common insurance terminologies, hoping to help you better understand the rules and regulations of U.S. health insurance so that you can maximize the use or choose the right insurance plan for you.

Introduction to Terminologies

Basic Information

In-network

When the hospital has a contract with your insurance provider to provide services at a discounted rate.

Out-network

When the hospital does not have a contract with your insurance provider and may charge a higher rate for services.

Benefit Details

Deductible

the amount you need to pay before your insurance comes into play

E.g. if the deductible is $200, and the bill is $500. You need to pay the first $200 out of $500 and then the rest $300 would be covered by insurance.

Note: unlike copay, in a given billing cycle, you only need to pay the deductible once at the very beginning before the insurance takes effect.

Inpatient/Outpatient Surgery

Inpatient surgeries require you to stay in the hospital after the operation, whereas outpatient surgeries do not. There are different inpatient and outpatient facilities in the VUMC system.

Coinsurance

The percentage of the cost of a covered health care service you pay after you've paid your deductible.

E.g. if the coinsurance is 20%, then you would have to pay 20% of the cost for the medical care service and your insurance would pay the remainder (80%)

Copay

The flat fee that needs to be paid to access certain medical services, including medication and medical consultation.

Out-of-pocket Maximum

The maximum amount that you are required to pay for covered healthcare services in a given year. Once you reach this limit, your insurance company will pay for all covered services for the remainder of the year.

Overall plan maximum

A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations.

Information about the Insurance

Explanation of Benefits (EOB)

A document provided by your insurance company after you receive healthcare services, outlining the services that were provided, the amount that was billed, and the amount that was paid by the insurance company.

Premium

The amount that you pay to your insurance company on a regular basis, usually monthly, in exchange for coverage. However, student insurance is usually paid annually.

Medical Services

Preventive Health Services

Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, diseases, or other health problems.

Pre-existing Condition

Any health problem you had before the date that new health coverage starts. Insurance companies can't refuse to cover treatment for your pre-existing condition or charge you more.

That's it for this article! We hope you have learned something. In the next issue, we will begin to provide Vanderbilt students with a detailed overview of what our Student Insurance Policy (SHIP) covers and some of the benefit rates. Stay tuned!