As you explore our site, you may come across an unfamiliar word or term. We've developed a glossary that we hope will help you.

A (10) B (6) C (17) D (8) E (9) F (5) G (3) H (10) I (7) L (1) M (5) N (6) O (6) P (20) Q (1) R (3) S (5) T (1) U (2) W (2)
Open access plan

A health plan that lets a member visit any doctor in the plan's network. A referral isn't needed from a primary care physician.

Open enrollment

A period during which individuals not previously enrolled in the health insurance plan are allowed to apply for coverage or change their coverage status.

Out-of-network co-insurance

The percent (for example, 40%) you pay of the allowed amount for covered healthcare services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-network co-insurance.

Out-of-network copayment

A fixed amount (for example, $30) you pay for covered healthcare services from providers who do not contract with your health insurance or plan. Out-of-network copayments are usually more than in-network copayments.

Out-of-pocket limit

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges or healthcare your health insurance or plan doesn't cover. Some health insurance or plans don't count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.


A patient who gets treatment at a hospital but doesn't stay there. For example, a member goes to the hospital in the morning for minor surgery. After waking up from the anesthesia, the doctor sends the patient home to recover.