Coinsurance – The payment percentage (ie. 20% in an 80%/20% arrangement) an insured is required to pay for a medical claim, apart from any copayments or deductibles.

Coordination of Benefits – When a member is covered by another group health plan in addition to their current coverage, coordination of benefits (COB) takes place. The COB provision is necessary to avoid duplication of benefits. To ensure that claims are processed properly, information about other coverage of any member must be furnished to Coventry Health Care promptly, and Coventry Health Care should be notified promptly of any coverage changes.

Copayment – The amount payable at the time covered services are received.

Covered Services – Services for which benefits are payable. Covered services are based on the health plan chosen by you or your employer. If you receive care for services that are not covered under the plan, the amount you pay for those services will not apply toward your deductible or out-of-pocket maximum.

Deductible – The amount you must pay out of your pocket for covered services in any one year before the health plan begins to pay.

Formulary – The list of medicines covered by a health plan as determined by a committee of doctors and pharmacists.

HSA- an HSA is a Health Savings Account combines high deductible health insurance with a tax-favored savings account. Money in the savings account can help pay the deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep. For more information click here.

Maximum Lifetime Benefit – The total amount the health plan will pay while you are covered.

Out-of-Pocket Maximum – If you incur unusually high expenses in any one year, most health plans include an out-of-pocket maximum. Under this provision, the health plan will pay 100 percent for most covered services after you have reached the out-of-pocket limit. For most health plans, the out-of-pocket expense is lower for in-network care and higher for out-of-network care.

Primary Care Physician (PCP) – The physician who is responsible for monitoring an individual’s overall health care needs. A PCP may be a general practitioner, family practice physician, internal medicine physician, OB/Gyn or a pediatrician.

Prior Authorization – Review performed by Coventry Health Care for certain procedures and services in order to determine if the services are approved for coverage under a benefit plan.

Specialist – A physician who provides medical services within a range of medical specialty.