Understanding your insurance policy can be overwhelming. This fact sheet defines various insurance-related terms.

A claim is a bill from your health care provider (doctor or hospital). Your health care provider sends a claim to your insurer to be reimbursed.

COBRA (The Consolidated Omnibus Budget Reconciliation Act)
COBRA is a law that lets you keep your insurance for 18 months, sometimes more. You pay the full cost.

Co-Payment (Co-pay)
Out-of-pocket cost you are expected to pay upfront for your health care services.

This is the amount of money you are expected to pay out-of-pocket towards your health care before your health care insurer pays. Out-of-pocket expenses typical do not include co-pays. For example - If your deductible is $3,000, you are expected to pay the first $3,000 towards your health care expenses. Your insurance will cover expenses after you have paid $3,000.

Flexible Spending Account
A flexible spending account (FSA) allows you to put pre-tax money from your paycheck into a special account that later can pay for certain medical expenses like copays. Each individual decides how much money per paycheck goes into their FSA account. It’s important to estimate your yearly medical expense that would qualify for FSA because this money typically does not roll over. A FSA can only be set up through an employer. Learn more about your options by talking with your employer about a flexible spending account.

In-Network or Network Provider
A health care provider selects health care professionals or hospitals to be a part of their insurance plan or network. These preferred health care providers or institutions cost less than others not in-network.

Out-of-Network or Non-Network Provider
Health care professionals or hospitals not a part of a health care provider’s insurance coverage. Going out-of-network generally costs more.

Medicaid is a social health care program that provides health insurance for individuals with limited resources.

Medicare provides health insurance for those 65 or older. Visit www.medicare.gov for more information.

A network is a large group of health care professionals, pharmacies and hospitals that are selected and preferred by an insurance company to provide care.

Money paid to have health insurance.

A provider is a health care professional (doctor, nurse, surgeon, etc) or institution (hospital) that provides care.

Need Help With Insurance Issues?

Call 800-813-HOPE (4673) and speak with a CancerCare professional oncology social worker who can help you explore your insurance options and find appropriate resources.

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This activity is supported by Bristol-Myers Squibb.

Last updated July 12, 2019

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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