Home / Insurance glossary
Insurance glossary
Plain-language definitions across medical, dental, vision, life, disability and employer benefits. Policy definitions control; terms may work differently between coverage types.
- Premium
- The amount paid to keep a policy in force, usually monthly. It is separate from deductibles and other care costs.
- Deductible
- The amount you pay for covered services before the policy pays under the applicable benefit rules. Some services may be covered before the deductible.
- Copayment
- A fixed amount you pay for a covered service or prescription, subject to the policy.
- Coinsurance
- Your percentage share of a covered expense, usually after any applicable deductible.
- Out-of-pocket maximum
- A medical plan’s limit on qualifying cost sharing for the benefit year. Premiums, uncovered services and generally out-of-network expenses do not count. Dental benefit maximums work differently.
- Network
- The providers or facilities participating under a specific plan. Verify the exact plan and location, not only the insurer name.
- Formulary
- A plan’s covered drug list, including tiers and restrictions such as prior authorization or step therapy.
- Waiting period
- Time before a policy or a particular benefit becomes available. Rules differ by product.
- Exclusion
- A service, condition or circumstance the policy does not cover.
- Annual benefit maximum
- The most a policy pays for specified benefits in a year, often used in dental coverage. This is different from a medical out-of-pocket maximum.
- Effective date
- The date coverage begins after all applicable enrollment, acceptance and payment requirements are satisfied.
- Beneficiary
- The person or entity designated to receive a policy benefit, such as a life insurance death benefit.
- Benefit period
- The period over which a policy measures or pays benefits; it may differ from a calendar year.
- Elimination period
- The time after a qualifying disability or other covered event before benefits begin under a policy.
- Guaranteed issue
- Coverage offered without medical underwriting under specific rules. It does not mean all benefits are unlimited or every applicant is eligible.
- Underwriting
- An insurer’s process for evaluating an application and determining acceptance, terms or rates where permitted.
- SBC
- Summary of Benefits and Coverage: a standardized overview of a health plan. Review full policy documents for complete terms.
- ACA Marketplace
- The exchange where eligible individuals and families shop for ACA health plans and apply for financial assistance.
- FPL
- Federal poverty level: commonly used shorthand for HHS poverty guidelines. Program rules determine which year and household definition apply.
- MAGI
- Modified adjusted gross income: the income measure used for Marketplace financial assistance, with specific tax adjustments.
- APTC / PTC
- Advance premium tax credit / premium tax credit: financial help toward eligible Marketplace premiums, subject to eligibility and tax reconciliation.
- CSR
- Cost-sharing reductions: extra savings on eligible Marketplace Silver plans that lower deductibles and other care costs.
- AV
- Actuarial value: the average share of covered medical costs paid by a plan for a standard population; not your personal guaranteed share.
- Open enrollment / SEP
- Open enrollment is the regular enrollment window. A special enrollment period requires eligibility under applicable event and timing rules.
- ICHRA / CHOICE ARRANGEMENT
- An Individual Coverage Health Reimbursement Arrangement allows an eligible employer to reimburse qualifying individual coverage expenses under plan rules.
- Affordability
- A defined test used in eligibility or employer rules. It differs from whether a household considers a premium comfortable within its budget.
Contact Benefits Direct · Privacy Policy · Insurance disclosures
Independent agency information. Not affiliated with or endorsed by the government, HealthCare.gov or Medicare. Services depend on producer licensing and authorization. This information cannot bind coverage.