Do you get your health insurance through your employer? Or maybe you have an individual self-funded plan. Regardless of how you are covered; there are a few common health insurance terms you need to learn when comparing different policies.

Common Health Insurance Terms

Copayment (or copay)

A fixed dollar amount you pay each time you get certain types of care. Your copayment will vary as a visit to your primary care physician would be different than a visit to a specialist or urgent care.


The amount you must pay for most health care services before your insurance begins to pay.


The cost you share for a covered service which is normally calculated as a percentage.

Coinsurance max

The most coinsurance you will pay toward covered services during a benefit year. This doesn’t include what you owe for your deductible, copayment and services not included in the coinsurance maximum.

Out-of-pocket max

The most you may have to pay for covered health care services during the year. This total includes your deductible, copayments, and coinsurance.


Although there are more terms that maybe of interest; these are the most common and recognizable terms used when comparing health insurance policies. By knowing and understanding them you can easily determine the best plan for you and/or your family.

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