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These are some common health plan terms and their definitions
NOTE: These definitions are for summary explanation only. Please refer to your policy for specific definitions related to your benefits.
A set dollar amount you pay each benefit period for covered services before your health plan policy begins paying benefits. Deductibles are reset each year.
A percentage (for example 20 percent) of the allowed amount you pay for a health care covered service. Coinsurance applies after the deductible has been met.
A fixed dollar amount (for example $20 or $30) you pay for specified covered services such as a doctor office visit.
A provider can charge you any amount for a service, but a health insurer may establish the maximum they will pay for a given covered service. The amount is often less than the charged amount. Contracting or contracted providers agree to accept the allowed amount (called the maximum allowance in your policy) as payment in full for a covered service and as part of their contract agree not to bill you the difference between the allowed amount and the charged amount.
Depending on your policy there may be a different benefit level for contracted and non-contracted providers. When you use providers out of the network, you may have to pay significantly more for your health care service.
An explanation of benefits form (EOB) lists the services for which you or your providers have sent claims for coverage. These forms are not bills but explain the results for each service submitted.
A service or type of service that is specifically excluded from coverage in your policy. Read your policy for a full list, but non-covered services often include those considered investigational or convenience items.
For more information, see the Student Plan Handbook. The Handbook provides you with an explanation of your benefits under the BYU-Idaho Student Health Plan and constitutes a legal contract between you and Deseret Mutual.