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The Healthy Living Magazine

Insurance Glossary

By Lindsey Wahowiak , ,

Chad Johnston/Measure Inc.

Getting ready to enroll in health insurance? This handy guide can help you make sense of the insurance jargon.

Co-pay: A small portion of the total cost of your office visit, paid directly after your appointment.

Exclusive provider organization (EPO): A type of insurance plan. You can only go to doctors in your insurer’s network, but you don’t need a referral for them.

Explanation of benefits (EOB): An outline of what your insurance provider paid after a doctor visit. This is not a bill.

Formulary: A list of medications and medical devices that your insurance plan covers.  You can also find this information by using the drug search tool on your insurance provider’s website.

Health maintenance organization (HMO): A type of insurance plan. With it, you need an in-network primary care doctor, who will give you referrals to specialists. Out-of-network visits are not usually covered.

In network: Health care providers who have agreed to a contract with your insurance provider. You can usually visit them for a cheaper co-pay.

Out of network: Health care providers who have not agreed to a contract with your insurance provider. If you have an HMO or EPO, your plan will not cover a visit to these providers, except in emergencies. If you have a PPO, your plan will likely cover part of or most of your care.

Preferred provider organization (PPO): A type of insurance plan. You can see any specialist without a referral, including out-of-network doctors.

Referral: A note from your primary care doctor that says you need to see a specialist. Needed for HMO plans.

Learn more about being an informed patient.