Healthcare and health insurance definitions.
An annual period, usually occurring shortly before the beginning of a new plan year, during which eligible people can enroll for health insurance benefits and/or change their elections from the previous year. Unless you have a qualifying special event, this is typically the only time of year that you can enroll in a health insurance plan.
See over-the-counter drug or medicine.
That area that is outside where the insurance company is making its coverage available for purchase.
The percent (for example, 40%) you pay of the allowed amount for covered healthcare services to providers who do not contract with your health insurance or plan. Out-of-network coinsurance usually costs you more than in-network coinsurance. See ACA Uniform Glossary
A fixed amount (for example, $30) you pay for covered healthcare services from providers who don’t contract with your health insurance plan. Out-of-network copayments usually are more than in-network copayments. See ACA Uniform Glossary.
Usually called a “nonparticipating” or “non-network” provider, this is a provider who is not a part of the panel of doctors and other providers selected for your health plan’s provider network.
Your out-of-pocket limit (or out-of-pocket max) is the most you could pay for covered care in a calendar year aside from your monthly premium. See ACA Uniform Glossary
A person who visits a clinic, emergency room, or health facility and receives healthcare without being admitted as an overnight patient.
Care that does not require an overnight stay in a bed in a licensed hospital, nursing home, or other facility.
A drug or medicine that is sold lawfully without a prescription.
