A Guide to Understanding Health Insurance Terms

Co-Pay

• A fixed amount you pay for a covered health care service, usually due when you receive the service. The amount can vary by the type of covered health care service.

Co-Insurance

• Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.

Rehabilitation

• Rehabilitative services refer to healthcare services that help you improve your functioning and daily living skills that you may have lost when you  were disabled, hurt, or sick. Rehabilitative services can include psychiatric rehabilitation services, speech language pathology, physical therapy, and occupational therapy in a wide range of outpatient and inpatient settings.

Habilitation

• Health care services that help a person keep, learn or improve skills and functioning for daily living

Deductible

• The total dollar amount you must pay before your health insurance plan begins to pay. Once you’ve met your deductible your insurance kicks in and starts paying a percentage of your services.  You will likely still owe a percentage (co-insurance) for future sessions.

In-Network

• An in-network provider refers to your physical therapist that is considered part of a network of preferred providers for a specific health insurance plan. Patients usually pay less for services they receive from in-network providers than for services they receive from out-of-network providers. Providers offer a discount for their healthcare services in exchange for the insurance company referring patients to them. 

Out-of-Network

• An out-of-network provider refers to your physical therapist that does not have a contract with your health insurance plan provider. Patients typically pay significantly more for services they get from out-of-network providers than for services they receive from in-network providers.

Out of pocket

•  Refers to the largest amount of money you might pay annually for health insurance coverage. The out-of-pocket maximum includes any co-insurance, co-payments, and deductibles and is an extra amount of money on top of the premiums that you regularly pay throughout the year. Once you reach your out-of-pocket maximum, the health insurance company will pay for any and all expenses for the rest of the healthcare year.