Terms to Know

Say what? Health care and health insurance can feel like they have a language all their own. This glossary can help you better understand common terms associated with your medical plan.

  • Ancillary Services. Services provided by health care providers other than a physician, such as laboratory, radiology or other diagnostic imaging, physical therapy or other services.
  • Benefit Year. The time period, usually the academic year, used to determine when you meet your annual deductible, benefit maximums, if any, and annual out-of-pocket maximum.
  • Coinsurance. The slice of a medical service you’re responsible for. For example, you might pay 20% of the cost for a particular service, and the insurance company or plan will pick up the tab for the remaining 80%.
  • Copayment. The flat fee you pay for covered services, usually due at the time you receive care. For example, you might pay a $15 copay to see a primary care doctor or specialist.
  • Coverage Period. The period during which a student and his or her covered dependents are eligible for coverage and receive the benefits of his or her plan.
  • Deductible. The amount you have to pay toward medical costs before UC SHIP starts paying part of the bill.
  • Emergency. An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm or death.
  • Inpatient. A patient who is admitted to the hospital.
  • Maximum Allowed Amount. The total reimbursement payable under your plan for covered services you receive from network and out-of-network providers. It is the claims administrator’s payment toward the services billed by your provider, combined with any deductible or coinsurance you may owe. If you receive services from an out-of-network provider, the provider will bill you the difference, if any, between their charges and the maximum allowed amount.
  • Network. A group of health care providers and facilities — including doctors, hospitals and labs — that contract with your health care plan to provide services at negotiated discount rates. You’ll usually pay less when you use a network health care provider. UC SHIP contracts with Anthem Blue Cross to provide access to its extensive network of hospitals and providers, including UC Family facilities and provider groups.
  • Out-of-Network. Health care professionals, hospitals, clinics and labs that do not belong to the Anthem Blue Cross Prudent Buyer PPO network. You’ll typically pay more and may need to file a claim for payment.
  • Out-of-Pocket Maximum. The maximum amount of money you’ll have to pay for health care in a benefit year. After you meet the maximum, UC SHIP covers 100% of all eligible costs for the rest of the benefit year.
  • Preferred Provider Organization (PPO). A group of medical or dental providers who contract with an insurance carrier to provide services for the insured at reduced rates.
  • Referral. Written authorization given by the student health center (SHC) to seek care outside the SHC for medically necessary services.