The total income for a family in a calendar year (See MAGI).

A request for your health insurer or plan to review a decision or a grievance again (usually in regards to whether or not a service is covered).

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill yo [..]

The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan’s coverage documents.

A request for payment that you or your health care provider submits to your health insurer after you receive items or services that you believe are covered by your plan.

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, co-insurance, and co-payments, but it doesn’t include premiums, balance bill [..]

The amount you must pay for covered health care services each year before your health insurance company will begin paying benefits. For example, if your deductible is $1,000, your plan won’t pay anyth [..]

Dependents are typically children or spouses/partners of insured individuals. When individuals or employees buy health insurance, they usually have the choice to buy a plan that covers their spouse, p [..]

Health care services that your health insurance or plan doesn’t pay for or cover.

A list of drugs your insurance plan covers. A formulary may also include how much you pay for each drug. If the plan uses “tiers,” the formulary may list the tier of each drug. Formularies may include [..]