The following are brief definitions of the terms and acronyms commonly used in regard to health insurance plans and health maintenance organizations.


Obtaining approval from the primary care physician as well as health plan (depending on the plan's specifications) prior to receiving health care services, such as visiting specialists, obtaining radiology scans and undergoing surgical procedures.


A claim is a request for payment for services and benefits you received.


The share of health care services paid by an enrollee. Coinsurance is generally found in conjunction with a deductible. Once the deductible is met, the enrollee is typically responsible for a specified percentage of the medical bill.


The fixed fee paid by the enrollee at the time of service such as office and emergency room visits. Co-payments are generally charged by health maintenance organizations (HMOs), point-of-service plans (POS) and some preferred provider organization (PPO) plans.