DEDUCTIBLE:
A deductible is the amount a member must pay out-of-pocket before insurance benefits kick-in. Deductibles are often listed annually, by individual and family. In other words, if you have a $300/$900 deductible, it means that $300 must be paid for an individual member OR $900 for the combined family before insurance will begin paying for services. Deductibles correspond to your plan's policy year (e.g. calendar or fiscal).

CO-PAYMENT/CO-INSURANCE:
A co-payment is the portion of the charge for the appointment that the member if responsible for. This amount may be a specific dollar amount, a percentage for the total charge, or a combination of the two.

PRE-AUTHORIZATION OF SERVICES:
Some plans require you, the member, to call in advance of your appointment to receive authorization for a covered service. Failure to obtain pre-authorization can result in the member being responsible for the entire fee for the service.

IN-NETWORK BENEFITS:
Many insurance plans have provider panels (professionals that are contracted with your insurance company), which are the professionals whose services the plan will pay the maximum benefit for.

OUT-OF-NETWORK BENEFITS:
Some plans allow members to "swing-out" of the panel and see any provider they choose. The main disadvantage of going outside your network is you may have to pay a higher deductible and/or copay than if you use a provider who is considered in-network.