Insurance terms
Welcome to our terminology page! Here, you'll find a comprehensive list of key terms and definitions relevant to the health insurance space.
In-Network
In-network refers to healthcare providers (doctors, hospitals, etc.) contracted with your insurance company to provide services at negotiated rates. Using in-network providers, who are included in your plan, often results in lower out-of-pocket costs for insured individuals.
Independent Review Organization
Within the healthcare industry, an independent review organization (IRO) acts as a third-party medical review resource which provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence.
Individual Mandate
The Individual Mandate, a key provision of the Affordable Care Act (ACA), required most Americans to have health insurance coverage or pay a penalty. It aimed to increase the number of people with health insurance to balance risk pools and keep premiums affordable.
Individual Market
Often referred to simply as the “Marketplace” or the “Exchange,” this service helps you shop for and enroll in health insurance for you and your family through websites, call centers and in-person help.
Insurance
Insurance is a contract, represented by a policy, in which a policyholder receives financial protection or reimbursement against losses from an insurance company.
Insurance Commissioner
An insurance commissioner is a public official in the executive branch of a state or territory in the United States who, along with their office, regulates the insurance industry.
Insurance Policy
A document detailing the terms and conditions of a contract of insurance.
Insurance Premium
Like a subscription fee, an insurance premium is the amount you pay, often monthly, to your insurance company to maintain your health coverage. It's the cost of having an insurance policy regardless of whether you use healthcare services.
Insured
An insured is a party who is insured against specific perils by either being the holder of an insurance policy or by otherwise being covered.
Insurer
An insurer is the insurance company or the party that agrees to compensate people, companies or other organizations for specific financial losses. In the case of health insurance, the insurer is the party that agrees to cover some or all of the costs for covered health care services in exchange for a premium.
