In the world of insurance, an accident is an unexpected and unavoidable event that results in a major or minor injury to the body.

This is the period in which a person covered by insurance has paid medical expenses that qualify toward satisfying that year's deductible. Don’t worry…we’ll explain what deductibles are, too!

Actual charge is the amount charged by health care providers for their services. It is not the same as the allowable charge, which is the amount your plan will cover. Think of this as the “retail price” rather than a “wholesale price” for medical services.

This is the amount your insurance has agreed to pay for health care services and supplies. This may be different from the actual charge billed by the health care professional. Your insurance carrier likely negotiated special rates for its members.

Annual limit is the maximum dollar amount an insurance company will pay for claims within a given year for any person they cover. Your plan details or benefit summary will list your yearly limit. This can also be called your calendar year maximum for dental plans. Some plans, such as certain types of HMOs, might not have an annual limit. And, under [..]

This is an insurance policy's year. It’s important to know that this timeframe may be different from the calendar year. Many insurance years begin in the fall or spring, for example. Benefits, rates, plan type or coverage levels may change at the beginning of a benefit year. And, annual limits are reset. If your employer provides you benefits, [..]

This is a formal request that’s made either by a plan participant or his or her healthcare provider to the insurance company, asking for payment for a procedure the member received. 

The amount a person with insurance coverage must pay for health care services after co-payments and deductibles are met.  It’s your portion of the healthcare cost for covered services.

A co-payment is a pre-set charge that an insurance plan requires its members to pay for services, prescriptions or medical supplies. For example, a co-pay for a visit with a specialist may be $25 with one insurance company, while a co-pay for annual teeth cleaning may be $15. The co-pay is different from insurance company to insurance company, and [..]

COB applies to you if you have more than one group insurance plans. Both plans typically work together to lower your out-of-pocket cost. One plan is considered the primary insurance plan. Once you receive the benefits outlined in your primary insurance, the secondary plan is then used. COB also ensures that claims are not paid multiple times.