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USEFUL
TERMINOLOGY
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Coinsurance – An arrangement set out in a health or dental insurance plan where
the insurance company and the plan member share the expenses according to a
specific formula (e.g., 80% covered by the plan and 20% by the member).
Deductible – The amount of the covered expenses that must be paid by the plan
member. In other words, the amount that is deducted from the expenses before the
claim is paid.
Eligible Expenses – These are costs that will be covered by a health or dental plan
as defined in the applicable contract/plan document before payment limitations
such as the deductible, coinsurance and applicable maximums are applied.
Health Care Spending Account – An arrangement where the plan sponsor allo-
cates a defined amount of funds to a member's account. These funds can be used
to reimburse the cost of health and/or dental claims not otherwise covered under
the group benefits plan.
Plan Member – The primary person to whom benefits are provided under the group
plan. This is the employee, union member or association member.
Plan Sponsor – This is the employer, union, association or other organization that
provides group health or dental benefits to its employees/plan members.
