Claim

Bill submitted to Priority Health by a provider office for medical care or drugs.

Coinsurance

After you've paid your deductible, coinsurance is your portion of the cost for medical services listed as benefits in your insurance plan or prescriptions listed in the approved drug list. For example, if your plan's fee for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. Priority Health would pay the rest of the fee, 80%.

Copayment 

Also known as copay. The portion you pay at the time you receive a health care service. You may also have a copay when you get a prescription filled. 

Cost share 

The part of health care costs that you have to pay based on your insurance plan. Examples include: deductibles, coinsurance, and copayments and similar charges.

Deductible 

The amount you pay each year before the health plan starts to pay for certain services. See your plan documents for details.

Explanation of Benefits (EOB)

An EOB is the summary of costs for the medical services you received over a certain amount of time. It shows you the discounts you received as a Priority Health member, what Priority Health paid toward your bill and what costs you can expect your provider to bill you.

An EOB is not a bill.

In-network

The specific doctors, hospitals or labs that Priority Health contracts with to provide health care services. When you have an in-network health care service, you usually pay less.

Narrow network plans

A narrow network is a type of health plan that requires members to receive care in their network of doctors, hospitals, outpatient facilities and labs to receive discounts through Priority Health insurance. If a member with a narrow network plan receives care out of network, they're responsible to pay for the full cost of their care.

Out-of-network

Services from doctors, hospitals and other health care professionals that have not contracted with Priority Health. Depending on the health care professional, the service could cost more or not be paid for at all by your plan.

Out-of-pocket limit 

The maximum amount of Deductibles, Copayments and Coinsurance you will pay for Covered Services in a Contract Year. Once you reach this maximum, Covered Services will be covered at 100% with no additional cost to you.

Premium 

The amount you pay for your health insurance. 

Preventive care includes specific health care services that help you avoid potential health problems or find them early when they are most treatable, before you feel sick or have symptoms. Examples of preventive care include flu shots, physical exams, lab tests and some prescriptions.

You pay $0 for preventive care services listed in your plan documents when received from an in-network provider.

We pay for preventive care services in full when you receive them from an in-network provider.

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