SBC Glossary of Health Coverage & Medical Terms:
This glossary has many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs. (See your Summary of Benefits and Coverage for information on how to get a copy of your policy or plan document.)
Bold text indicates a term defined in this Glossary. See page 4 of the PDF download for an example showing how deductibles, co-insurance and out-of-pocket limits work together in a real life situation.
Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.)
A request for your health insurer or plan to review a decision or a grievance again.
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GLOSSARY OF TERMS
Find a list of commonly used terms and definitions that can help you better navigate your benefit plan.
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