KEY MEDICAL TERMS P C P A P r i m a r y C a r e P h y s i c i a n d e s i g n a t e d wit h your h ea lt h p l a n w h o provides t h e first co n t a ct of care. T h e P C P will also provide referrals for specialist ser vices a s n e e d e d D E D U C T I B L E T h e a m o u n t yo u n e e d to p a y e a c h year for eligible healthcare e x p e n s e s before in su r a n ce p a y m e n t s b e g i n C O P A Y A fixed a m o u n t yo u p a y e a c h t i m e yo u g e t a healthcare ser vice [doesn’t apply to HMO (with HRA ) & PPO HSA (with HRA ) plans] C O I N S U R A N C E T h e p e r c e n t a g e of costs of a co vered healthcare ser vice yo u p a y (i.e. 20%) after yo u h a v e p a i d your deductible. F o r examp le: Yo u receive a ser vice for $100 that requires yo u to p a y coinsurance. Yo u r d e d u c t i b l e h a s b e e n met. Yo u will p a y 2 0 % of t h e $100 ser vice, or $20. [doesn’t apply to HMO (with HRA ) & PPO HSA (with HRA ) plans] O U T - O F - P O C K E T M A XIM UM T h e m a x i m u m a m o u n t yo u p a y e a c h year for eligible healthcare e x p e n s e s in deductible, co paymen ts, a n d co in su r an ce [doesn’t apply to HMO (with HRA ) & PPO HSA (with HRA ) plans] A L L O W E D A M O U N T M a x i m u m a m o u n t o n w h i c h p a y m e n t is b a s e d for co vered h ea lt h ca re ser vices. This m a y b e called “eligible expense,” “ p a y m e n t allowance,” or “negotiated rate.” If your provider c h a r g e s m o r e t h a n t h e allowed amo u n t, a n d is o u t of network , yo u m a y h a v e to p a y t h e difference . B A L A N C E B I L L I N G (Ou t of network) W h e n a provider bills yo u for t h e difference b e t w e e n t h e provider ’s c h a r g e a n d t h e allowed a m o u n t . F o r examp le, if th e provider ’s c h a r g e is $100 a n d t h e allowed a m o u n t is $70, t h e provider m a y bill you for th e r e m a i n i n g $30. A preferred provider m a y n o t b a l a n c e bill yo u for co vered ser vices.