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Frequently Asked Questions

Health Insurance Terms to Know

Co-insurance: A percentage of your medical bill that is shared by you and your insurance company after your deductible has been met.

Copay: A predetermined fee you pay for health care services in addition to what’s covered by insurance. Not every type of health insurance plan requires a copay.

Deductible: The amount you have to spend on your medical care each year before your health insurance plan starts helping you pay.

Health Insurance Marketplace: The Health Insurance Marketplace is a resource for individuals and families to shop for and enroll in a health insurance plan. It also provides information on programs that can help people pay for coverage.

Network: A group of doctors and hospitals that participate in the same health insurance plan. You pay lower out-of-pocket costs if you go to doctors and hospitals that belong to your plan’s network.

In-network: Health care providers who have contracted with your insurance company to accept certain negotiated (i.e., discounted) rates.

Out-of-network: Health care providers who have NOT agreed to the discounted rates.

Open Enrollment: The period of time that qualified individuals can sign up for a health insurance plan or switch to a new plan.

Out-of-pocket Costs: Your total expenses for medical care that are not paid by your health insurance plan.

Policy: The contract between you and your insurance company that provides specific coverage details for the health plan you selected.

Premium: The amount you pay each month to keep your health insurance plan active.

Uninsured: You are not covered by health insurance and your medical bills will be your financial responsibility.

Responsible Person Number: The number that shows your overall balance for each account/visit that is patient responsibility. This number is located on the top right portion of your statement and under the Overview section in MyAtriumHealth.

Account Number: Specific date of service or visit; there are many account numbers under one Responsible Person Number. This number is located on the detail portion of the statement and under the Detail tab in MyAtriumHealth.

Explanation of Benefits (EOB): A statement from the health insurance company explaining what medical treatments and/or services were paid for on their behalf to include any patient responsibility.

Hardship Discount: A discount program for insured patients or uninsured patients who are over the income limit for Coverage Assistance and Financial Assistance (CAFA).