We would like to make you feel comfortable, and would like to have it so any and all of your questions are answered. We have included a glossary of terms of the various topics that are on this website. Please feel free to check through this glossary to find the answer to any of your ideas, questions, or concerns.

Certificate of Coverage: 
A document given to an insured that describes the benefits, limitations and exclusions of coverage provided by an insurance company

Claim:
Form submitted to a payer (by a health care provider or patient) to request payment for items or services

Co-insurance:
Cost-sharing arrangement between an insured person and the health insurance company in which the insured person is required to pay a percentage of the cost for the health care services received.  Coinsurance typically applies after satisfaction of a deductible.  For example, 80% coinsurance may apply after a $500 deductible has been satisfied.

Consolidated Omnibus Budget Reconciliation Act (COBRA):
The Consolidated Omnibus Budget Reconciliation Act of 1985, commonly known as COBRA, requires group health plans with 20 or more employees to offer continued health coverage for employees and their dependents for 18 months after the employee leaves the job.  Longer durations of continuance are available under certain circumstances.  If a former employee opts to continue coverage under COBRA, the former employee must pay the entire premium, plus a 2% administration charge.

Contract Year:
The period of time from the effective date of the contract to the expiration date of the contract.  A contract year is typically 12 months long, but not necessarily from January 1 through December 31.

Coordination of Benefits (COB):
A provision in the contract that applies when a person is covered under more than one health insurance plan.  It requires that payment of benefits be coordinated by all plans to eliminate over-insurance or duplication of benefits.

Co-payment (Co-pay):
Co-payment is a predetermined fee, in addition to what health insurance covers, that an individual pays for health care services.  For example, a PPO may require a $20 "co-payment" for normal services delivered during a physician office visit.

Cost Sharing:
This occurs when the users of a health care plan share in the cost of medical care. Deductibles, coinsurance, and co-payments are examples of cost sharing.

Covered Benefit:
A health service or item that is included in a health plan, and that is partially or fully paid by the health plan

Covered Charges/Expenses:
Most insurance plans, whether they are PPOs or HMOs, do not pay for all services.  Some may not pay for prescription drugs.  Others may not pay for mental health care.  Covered services are those medical procedures for which the insurer agrees to pay.  They are listed in the policy.

Covered Person:
An individual who meets eligibility requirements and for whom premium payments are paid for specified benefits of the contractual agreement.