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Glossary of health insurance terms

Knowing these terms can help you choose a health insurance plan that meets your needs.

Health insurance is full of terms you may not know. To help you better understand health insurance, here’s a list of the most commonly used health care terms and definitions.

Learn more about upcoming changes to the City of Boston's Non-Medicare health plans and benefits available to City workers and retirees.

Terms and definitions by topic

Terms and definitions by topic
Health Maintenance Organization (HMO)

A plan that usually limits coverage to care from doctors who contract with the HMO. It generally will not cover out-of-network care except in an emergency. An HMO requires you to live in its service area to be eligible for coverage. HMO plans also require a referral from your primary care doctor to see a specialist.

Value Network HMO

A plan that excludes the highest cost providers, as determined by the health insurance provider. It includes only lower-cost providers that meet a certain quality threshold.

Preferred Provider Organization (PPO)

A plan in which you pay less to use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPO plans do not require a PCP referral for a specialist visit.

Advanced Imaging:

CT/PET scans, and MRIs.

Annual Enrollment:

The yearly period when employees and retirees can enroll in and change health insurance plans and coverage without a qualifying life event.

Copayment:

A fixed amount you pay for each covered healthcare service, in addition to your premium and any deductible.

Deductible:

A fixed amount an employee pays for certain services before the insurer begins to pay for those services.  Members pay in full for certain services until reaching the annual maximum deductible amount.

Inpatient Hospital:

Care that you receive when admitted (acute, medical rehabilitation, and skilled nursing care). Excludes mental health and substance use disorder.

Outpatient Hospital:

Care that you receive without being admitted or for a stay of less than 24 hours.

Premium Share:

The percent of premium you pay for health insurance every month (from paycheck or pension). The employer pays the remaining percentage.

Primary Care Physician (PCP):

A physician who directly provides or coordinates a range of health care services for a patient.

Specialist:

A physician who focuses on a specific area of medicine or a group of patients to:

  • diagnose
  • manage
  • prevent, or
  • treat certain types of symptoms and conditions. 
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