Insurance Matters

Health insurance has a language all its own.

September 2020

Health insurance terms 101.

Health insurance has its own language. Many terms can be unfamiliar and some can be downright confusing. But the more you understand the lingo, the better equipped you’ll be to make smart healthcare decisions.

Here are a few of the terms you’ll come across most often – as well as what they mean.

Coinsurance: The percentage of an allowable charge you must pay for a covered service. Generally, your deductible must be met before your coinsurance applies.

Copayment (Copay): If your plan has copayments, they are the amount you pay each time a certain covered service is received.

Covered Services: Healthcare services, supplies, equipment, and care listed in a member’s certificate or contract, with the exceptions of excluded conditions and limitations that are also identified in the certificate or contract.

Deductible: This is the amount that must be incurred by each member of the policy before benefits become payable by Blue KC.

Explanation of Benefits (EOB): A statement sent listing healthcare service(s) obtained, amount(s) paid by the plan, and the total amount that a member may owe to a provider.

Service Area: This is the geographic area served by Blue KC, which includes 32 counties in the greater Kansas City area and northwestern Missouri.

Visit the Blue KC Glossary for more definitions, as well as our Frequently Asked Questions page for answers to things we’re asked about most.

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