Help & guides · Plain English · Houston, Texas
Insurance words, explained like a neighbor would.
You shouldn't need a dictionary to protect your family. Here is every confusing insurance word, in plain English — no jargon left unexplained.
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Enrollment guide
A walkthrough of signing up for a plan, one step at a time, with an example form filled in.
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Every carrier's official site, and how to reach member services — all in one place.
Talk to a person
Call 281.493.6862. A real person in Houston will explain it, no matter how basic the question feels.
The glossary
Every word, explained twice: the real definition, then the neighbor version.
Premium
The amount you pay every month to keep your plan active.
In other words: this is your insurance bill. You pay it whether you go to the doctor that month or not.
Deductible
What you pay first, before the plan starts helping.
In other words: the plan doesn't chip in until you've spent this much yourself this year.
Copay
A flat fee you pay each time you get certain care, like a doctor visit or a prescription.
In other words: it's like a cover charge. You pay the same amount every time, no matter what the total bill is.
Coinsurance
After you meet your deductible, this is your share of the bill — usually a percent, like 20%.
In other words: the plan pays most of it, but you still pay a slice, on top of your premium and deductible.
Out-of-pocket maximum
The most you can pay in a year for covered, in-network care. This is the single most important number for families facing big medical bills.
In other words: once you hit this number, the plan pays 100% of covered, in-network care for the rest of the year. This is the number that protects your family's savings.
Network / in-network / out-of-network
The network is the group of doctors, hospitals, and clinics that have a deal with your insurance company. In-network costs you less. Out-of-network can cost much more, or may not be covered at all.
In other words: before you go to any doctor, check if they're in your network. It can be the difference between a small bill and a huge one.
HMO vs. PPO vs. EPO
These are plan types. HMO: you pick a primary doctor and need a referral to see a specialist, and it usually costs less. PPO: you can see almost any doctor without a referral, and it usually costs more. EPO: you stay in-network like an HMO, but you don't need referrals like a PPO.
In other words: it's a trade. HMO trades freedom for a lower price. PPO trades a higher price for freedom to see almost anyone. EPO sits in between.
Prior authorization
Permission your doctor must get from the insurance company before certain treatments, tests, or medicines are covered.
In other words: it's asking permission first. If your doctor skips this step, the plan may not pay — even if you needed the care.
Explanation of Benefits (EOB)
A paper or email from your insurance company that shows what a visit cost, what the plan paid, and what you might still owe.
In other words: this is not a bill. It's a summary. The real bill, if you owe one, comes separately from the doctor or hospital.
Subsidy (Premium Tax Credit)
Money from the government that lowers your monthly premium, based on your income.
In other words: many families qualify without knowing it. It can turn a plan you thought you couldn't afford into one you can.
Open Enrollment
The yearly window when anyone can sign up for a health plan or change their plan.
In other words: miss this window, and you usually have to wait until next year — unless you have a qualifying life event.
Special Enrollment Period
A short window outside of Open Enrollment when you're allowed to sign up or change plans, triggered by a big life change.
In other words: it's a second chance to enroll — but it usually only lasts a matter of weeks, so don't wait to act.
Qualifying life event
A major change in your life — losing a job, having a baby, getting married, moving — that opens a Special Enrollment Period.
In other words: these are the moments that let you get or change coverage outside the normal calendar.
Formulary (drug list)
The list of medicines your plan covers, and how much you pay for each one.
In other words: before you fill a prescription, check the formulary. The same medicine can cost very differently depending on which tier it's listed in.
HSA (Health Savings Account)
A special bank account for medical costs, available with certain high-deductible plans. Money you put in isn't taxed.
In other words: it's a savings account just for health costs. It's yours to keep, even if you change jobs.
Still confused? That's normal.
Call us — explaining this is the job.