Common U.S. Health Insurance Terms & Policies

Health insurance in the U.S. is complicated and very different from the medical practices of other countries.  It is your responsibility to understand the benefits that you are entitled to under the plan you select.  Familiarize yourself with basic terminology and understand the policy terms, exclusions, and costs of the insurance plan.  Being informed is the best way to be prepared should you or your family need medical care while in the U.S.  

For your reference, here are some commonly used terms in the U.S. health insurance system to help you understand your insurance benefits:

  • Copay: A specified dollar amount that you will need to pay for a certain covered medical expense.  Most insurance plans will require this type of payment for every doctor’s visit. 
  • Coinsurance:  The percentage of the total medical bill you are responsible for paying.
  • Deductible: The amount of money you must pay, in each case of accident or illness, before the insurance company starts paying.  Some insurance policies have an annual deductible; others will have a deductible per illness or injury.  It is important that you think carefully about how much you can afford before selecting a plan.
  • Dental Insurance:  Most insurance policies will not cover dental procedures, so separate dental insurance is usually required for any dental care that you may need to receive in the United States. However, you can pay for dental care from your own personal funds.  Dental procedures in the U.S. are expensive.
  • Preexisting Condition: A medical condition determined to have been in existence before the policy went into effect.  Most insurance policies consider pregnancy a preexisting condition. 
  • Pregnancy & Maternity:  Many insurance policies do not cover pregnancies that occur either before arrival to the U.S. or during J-1 stays in the U.S.
  • Premium: The amount you must pay to purchase the insurance coverage.  Age, medical history, duration of insurance, and number of dependents are some factors that will affect how much your premium will ultimately cost.
  • Provider Network: Providers (doctors/hospitals) with whom the insurance company has an agreement. Coverage levels are higher at in-network providers.