Understanding health care can be difficult when insurers and the medical industry use a lot of specialized language. These are a few of the most common terms you’ll encounter in health care and insurance:

Claim: a claim is an application for benefits from the insurance company, typically to pay for services of a health care professional

Co-Insurance: the amount that an individual is required to pay for health care services; for example, insurance may pay for 80% of a procedure, leaving the individual to pay for the remaining 20%

Consumer Operated and Oriented Plan (CO-OP): a CO-OP is a non-profit organization run by its customers that offers affordable health insurance options; the customers/members elect its own board of directors, the majority of which must belong to the co-op

Co-Payment: a flat fee paid by the individual at the time of services; for example, an office visit may entail a $10 co-pay at the time of the visit

Deductible: the amount that an individual has to pay before insurance covers health care costs; most health care plans involve an annual deductible

Denial of Claim: when an insurance company refuses to honor a request to pay for health care services

Essential Health Benefits: the Affordable Care Act requires all health insurance policies sold in state health insurance exchanges to cover essential health benefits, such as maternity coverage, substance abuse coverage, mental health coverage and prescription drug coverage

Health Maintenance Organization (HMO): an HMO is a pre-paid insurance plan where individuals or employers pay a fixed monthly fee for services, and services are only covered when they’re provided by physicians employed by, or under contract with, the HMO

Preferred Provider Organization (PPO): in a PPO, physicians partner with an insurer or third-party provider to provide health care at a discount; individuals can go to providers outside of the network, but they typically pay more for care

Primary Care Provider (PCP): a primary care provider is the main physician who monitors an individual’s health care needs, and can refer an individual to specialists or other physicians for specific care or treatment

For more information, or help with a specific health care term, take a look at the Uniform Glossary of Terms compiled by the Center for Consumer Information & Insurance Oversight.