From copays to deductibles, HMOs and PPOs, find clarity in insurance term literacy. Learn the lingo with this easy-to-understand glossary of the most commonly used (and misunderstood!) words and phrases.
- Annual Maximum (Dental): The maximum amount the dental insurance plan will pay out towards your claims in the calendar year of your policy.
- Co-Insurance: Your percentage share of cost for a covered health care or dental service, after the deductible has been met.
- Copay: A fixed dollar amount for an office visit with a physician or a prescription.
- Deductible: A specified amount of money you pay for covered health care services before your insurance plan starts to pay.
- Elective Contacts: Contacts for members who can elect to wear glasses or contacts.
- HMO (Health Maintenance Organization): A health plan that requires a member to choose a primary care physician (PCP) that is part of their designated network. PCP referral is required for specialty services (e.g. dermatology, labs, diagnostic).
- Non-Elective Contacts: Contacts for members whose vision cannot be corrected with glasses.
- Out of Pocket Max: The most you could pay in a calendar year for In-Network covered health care services.
- PPO (Preferred Provider Organization): A health plan that allows patients to choose any physician or specialist, either inside or outside their network. Out of network providers will result in higher costs.
- Standard vs Progressive Lenses: Standard lenses have a line separating the different vision corrections (e.g. bi-focal or tri-focal). Progressive lenses include different vision corrections without the visible line.
- UCR (Usual, Customary, Reasonable): If your plan covers the 90th% UCR charge, that means out of network claim are paid based on what 9 out of every 10 dentists in your local area charge. You are responsible for any balance above that amount.
