Premium
The amount you or your employer pays in exchange for insurance coverage.

Out-Of-Plan
This phrase usually refers to physicians, hospitals or other health care providers who do not contract with the insurance plan usually HMOs and PPOs. Depending upon the insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual's insurance company.

Co-insurance
Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health plans, coinsurance is called a co-payment. Co-insurance is often specified by a percentage. For example, the employee pays 20% toward the charges for a service and the employer or insurance company pays 80%.

Capitation
Capitation represents a set dollar limit that your health maintenance organization HMO pays to your primary care physician for providing medical treatment to you and your dependents. This fee is usually paid to the physician on a monthly basis. The physician gets no more or no less than this set fee no matter how much you use his or her services.

Basic Benefits
Basic Benefits includes both Medicare-covered benefits (except hospice services) and additional benefits.

Deductible
The amount an individual must pay for health care services before insurance covers any of the costs. Deductibles are most frequently charged on an annual basis rather than on a per incident basis.

Managed Care
The system that HMOs, PPOs and indemnity plan uses to provide quality health care while controlling the costs of medical services that individuals receive.

Basic Benefits Package
A defined set of health care services for which coverage must be available in each health insurance policy of plan.

Case Management
Case management is a system that insurance companies and HMOs use to ensure that individuals receive appropriate, timely, and reasonable health care services.

Primary Care Physician PCP
A health care professional who is responsible for monitoring an individual's overall health care needs. Typically, a PCP serves as a gatekeeper for an individual's medical care, referring the individual to specialists and admitting them to hospitals when needed.