Agent: An individual, licensed by the state and appointed by an insurer, to solicit, negotiate, effect or countersign insurance contracts on behalf on the insurance company.

Allowable charges: The price the carrier determines is reasonable for care or supplies.

Annual out-of-pocket maximum: The maximum amount a member will pay in coinsurance for services; then coverage is paid 100 percent by the carrier.

Broker: A licensed individual whom an employer pays to negotiate for insurance from companies.

Coinsurance: A percentage of allowable charges (usually an 80/20 split) for which the member is responsible after satisfying the deductible.

Consultant: An individual who advises prospective purchasers of insurance products regarding the coverage, difference in coverage or contracts. The consultant does not have to be licensed by the state.

Co-payment: A set fee members must pay each time they use a particular benefit.

Deductible: A set amount a member must pay before the carrier starts paying for claims.

Indemnity: See Traditional Coverage.

Health Maintenance Organizations (HMO): HMOs are a type of managed care plan. Members of HMOs choose a primary care physician who will coordinate their routine medical care and provide treatment for a variety of conditions. The primary care physician authorizes referrals to specialists and non-emergency visits to hospitals. HMO members must use health care providers in their network, but have minimal or no deductibles and lower out-of-pocket costs than other health care plans.

Health Savings Account: A way for employers and employees to save for healthcare expenses in non-taxed, interest-bearing accounts. HSAs are high-deductible health plans with a savings mechanism administered by a financial institution. They are available to individuals and any size group. The accounts have a maximum contribution level. Contributions to the account can be made by individuals, employers and/or employees; and the contributions are tax-deductible to the employer. Pre-tax or tax-deductible contributions can be made by the employee (the employee always owns the account). HSAs are portable if the employee changes jobs, and they can be rolled over.

Network provider: A provider who has agreed to accept pre-set amounts in payment for services to enrolled members of a health care plan. Depending upon the type of health care plan, people may seek care only from a provider in a network, or will face higher costs or no reimbursement for services sought by a non-network provider.

Point of service (POS): A primary care physician acts as a gate keeper to further medical care. The member pays fewer out-of-pocket expenses than with a contracted physician and has the option to go outside of the network at an increased cost.

Preferred provider organization (PPO): Health insurance with no primary care physician limitations. Instead, a list of preferred providers allows for fewer out-of-pocket expenses.

Traditional coverage: Health insurance with no network or primary care physician limitations. Members typically pay a deductible and a percentage of their insurance costs.