Co-Insurance: The percentage or amount of eligible expenses that the insured pays after the deductible.
As an example, "Co-Insurance = 20% or 80/20" means that the insurance company pays 80% of the charges, the insured pays 20%. Often in many plans there is a maximum co-pay amount, i.e., a limit which the insurance provider pays 100%.

Example: "Deductible = $250 and 80/20 co-pay up to $5000, then 100% up to policy maximum." This means the insured is required to pay the deductible of $250 plus 20% of expenses up to $5,000, and the insurance provider pays 100% of covered expenses that exceed $5000 up to the maximum policy coverage limit

Deductible:This is the amount that must be paid by the insured before the insurance company begins to reimburse for covered expenses . This works like your Auto insurance deductible where certain amount the insured need to pay.

As an example, if you purchase a plan with a $500 deductible and incur $1500 of expenses, the insurance company will begin to reimburse for expenses after you have paid the initial (Deductible) $500.

Exclusions: This can be defined as the expenses that the insurance company/plan will not pay. Examples: expenses resulting from illegal drug use, conditions which existed prior to the purchase of the insurance (pre-existing conditions), participation in various dangerous activities. Read coverage carefully for these exclusions in your plan.

Hospital Indemnity: is a type of rider/insurance that pays a fixed amount for each day that you are in the hospital. This need not to be medical related expense it can be used for any purpose.

Intensive Care: or critical care is concerned with providing greater than ordinary medical care and observation to people in a critical or unstable condition. The provision of intensive care is generally administered in a specialized unit of a hospital called the Intensive Care Unit (ICU) or Critical Care Unit (CCU).

Inpatient: Medical treatment that involves/requires overnight stay at a hospital.

Maximum Coverage: The maximum limit/amount of money that the insurance provider will pay for covered expenses. This may be an overall maximum or an amount for each illness/accident.

Outpatient: Medical attention that does not include an overnight stay at a hospital.

Pre-existing Conditions: Generally, pre-existing conditions are defined as medical conditions, medication, consultation, or treatment which existed or which were performed prior to the effective date of coverage.

Premium: The amount you pay to purchase medical insurance plan. Premiums may be paid full in advance or monthly or depending on the policy.

Renewable or non Renewable: This feature (Renewable) tells whether the particular plan/policy can be continued and not be treated as a new policy.

This feature has a significance in way that if something happens in previous months, that will not be considered as pre-existing condition where as the new policy will consider it as a pre-existing condition. So if you extend your stay and like to renew the policy the same policy can be renewed.

Policy Administrator: The company that administers, the policies – providing claims processing, customer support, provider information, benefits approval, etc. Example Blue Cross is the administrator for the Tonik plan.

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Carrier/Underwriter: The insurance company that actually carries the risk associated with the plans. Example: Blue Cross Life is the underwriter for the Tonik plans.

URC: Usual, customary and reasonable charges , (URC) charge is an established maximum amount that an insurance company will reimburse for a medical expense covered under your health insurance policy. URC charges are generally determined based on charges that are actually billed by providers for each medical procedure or service in a geographical area.