Terms to understand before you get started.

20 Health Insurance Terms You Need to Know

Annual limit

The ACA currently prohibits health insurance plans from putting an annual dollar limit on the benefits individuals receive. However, plans can put a limit on spending if the service provided doesn’t fall within the essential health benefits


Individuals may request that their health insurance company review a decision that denies benefit or payment. Every individual has the right to appeal a decision.


Refers to a request for payment the individual’s health care provider submits to the insurance company when the individual receives items or services they believe should be covered


A fixed amount the individual pays for covered health care services after the deductible has been met.


Have questions? What conditions are considered pre-existing conditions? What conditions are no longer considered pre-existing conditions? What is the six-month exclusion period? When does it begin?  Read our FAQ for all the answers…

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I worked in the health insurance industry for years. Every day I fielded questions from people concerning their coverage and medical bills. I learned a lot about how the industry works, the limitations and challenges health insurance companies face, and the limitations and challenges faced by their customers.