KEY MEDICAL TERMS PCP A Primary Care Physician designated with your health plan who provides the first contact of care. The PCP will also provide referrals for specialist services as needed. Maximum amount on which payment is based for covered healthcare services. This may be called “eligible ALLOWED AMOUNT expense,” “payment allowance,” or “negotiated rate.” If your provider charges more than the allowed amount, and is out of network, you may have to pay the difference. DEDUCTIBLE The amount you need to pay each year for eligible healthcare expenses before insurance payments begin. COPAY A fixed amount you pay each time you get a healthcare service. COINSURANCE The percentage of costs of a covered healthcare service you pay (i.e. 20%) after you have paid your deductible. For example: You receive a service for $100 that requires you to pay coinsurance. Your deductible has been met. You will pay 20% of the $100 service, or $20. OUT-OF-POCKET MAXIMUM The maximum amount you pay each year for eligible healthcare expenses in deductible, copayments, and coinsurance. (Out of network) When a provider bills you for the difference between the provider’s charge and the allowed BALANCE BILLING amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.