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Insurance Definitions

Health insurance in the U.S. can be confusing. This page explains common insurance terms in simple language, so you can better understand your coverage and choices.

Coinsurance is the portion of a bill the insurance plan pays after you pay your deductible and/or copay.
Coinsurance is typically shown as two percentages: one for in-network providers and one for out-of-network providers.

For example, a student might have a plan with 100% / 80% coinsurance.

  • If this student goes to an in-network provider, insurance pays 100% of the bill for covered services (after any deductible or copay is paid).
  • If this student uses an out-of-network provider, insurance pays 80% of the bill for covered services (after any deductible or copay is paid). The student pays the remaining 20% until they reach their out-of-pocket maximum.

A copay, or copayment, is a set dollar amount you pay for healthcare services each time you use your insurance.

A copay is often paid when checking in for a medical appointment.

Copay amounts can be different depending on the type of care you receive. For example, copays may vary for regular doctor visits, specialist visits, urgent care, emergency room visits, and prescription medications. Some services may even have a $0 copay.

A deductible is the amount of money you have to pay for your medical care first, before your insurance starts helping to pay.

A deductible can be annual or per illness and injury, so be sure to check how your plan is set up.

Inpatient care and services occur when you are admitted to the hospital for medical treatment and stay overnight or longer.

Medical evacuation involves moving a patient from one medical facility to another for needed care. Transportation may include ground ambulances, air ambulances, helicopters, or maritime transport during a medical emergency.

An out-of-pocket maximum is the most money you will have to pay for covered medical care in a year. Once you reach this amount, your insurance typically pays 100% of covered costs for the rest of the year.

Outpatient services are healthcare visits that you attend and leave within the same day.

An outpatient visit can become an inpatient visit if you are admitted to the hospital during an initial outpatient visit.

A plan maximum is the highest amount the insurance company will pay for your covered medical care during the policy period. There are usually two types:

  1. Annual Plan Maximum: The most money your insurance company will pay for all medical care combined during the policy year.
  2. Per Injury or Illness Plan Maximum: The most your insurance company will pay for one specific injury or illness during the policy year.

Once a plan’s maximum benefit is reached, insurance stops paying for covered expenses that policy year. Any costs beyond that limit become your responsibility and your “out-of-pocket maximum” no longer applies.

A pre-existing condition is a health issue you already had or currently have before your insurance coverage started/starts. Examples include asthma, diabetes, cancer, or pregnancy.

The premium is the amount you pay to have insurance. Think of it as the “price” of the insurance plan.

Premiums are shown as either the cost per day, per month, or for the whole year.

Some plans offered on the Lewerglobal website require a minimum of a 5-day coverage period, while other plans require a minimum of one month (or 30 days).

Preventative care is medical care you receive to prevent illness or injury; it is not meant to diagnose or treat an illness or condition. It is meant to keep you healthy and avoid any threats to your health.

Preventative care includes, but is not limited to:

  • Routine checkups
  • Routine lab work
  • Routine screenings
  • Vaccines and immunizations

Coverage varies by plan. Some plans offered through Lewerglobal include preventative care with a maximum dollar limit, while others do not cover preventative care.

Repatriation is coverage for costs associated with returning a policyholder to their home country in the event of a medical emergency, illness, or death while traveling abroad.