Terms to Know

Allowable Charges: The maximum dollar amount that an insurance company will reimburse a provider for a specific service.
Biologically based mental health condition: The following disorders are considered biologically-based conditions: schizophrenia/psychotic disorders; major depression; bipolar disorder; delusional disorders; panic disorder; obsessive compulsive disorders, anorexia and bulimia.  All other mental health conditions are considered to be non-biologically based conditions.

Co-pay: The specific dollar amount that you may be required to pay out-of-pocket for a specific type of service.

Co-insurance: The amount you are required to pay for covered healthcare services after you have satisfied any co-pay or deductible required by your health insurance plan.

Deductible: The amount you are required to pay out-of-pocket before the insurance company begins paying for your healthcare claims.

Insurance Charge: The amount paid to the health insurance company to maintain your coverage.

LOA: Leave of absence

Network: A group of doctors, hospitals and other healthcare providers contracted to provide services to insurance companies’ customers for less than their usual fees.

Out-of-Pocket Limit (OPL): The predetermined limited amount of money that an individual must pay out-of-pocket before an insurance company will pay 100% of healthcare expenses.

Patient Protection and Affordable Care Act (ACA): The Affordable Care Act (ACA) was enacted to increase the level of health insurance coverage to more Americans.  There are a multitude of medical coverage requirements set forth in the law.

Reasonable and Customary Charge: The average fee charged by a particular type of healthcare provider within a geographic area.

SHC: Student Health Center