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.
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 period during which individuals not previously enrolled in the health insurance plan are allowed to apply for coverage or change their coverage status.
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.
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 usually are more than in-network copayments.
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.