Premium
The monthly cost you pay to keep coverage active, whether or not you use medical services that month.
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Glossary
Plain-English definitions for the terms that make plan shopping feel harder than it should.
Use this glossary when you run into unfamiliar language while comparing Indiana individual health, short-term, dental, HSA, and Medicare-adjacent coverage.
Most-Used Terms
Start here when a plan brochure or enrollment screen gets too abstract.
Definitions vary slightly by carrier and policy language, but these explanations should give you a stronger working understanding before you review the actual plan documents.
Deductible
The amount you typically pay for covered services before the plan starts sharing more of the cost, subject to the policy rules.
Copay
A set dollar amount for a visit, prescription, or service instead of paying the full billed amount yourself.
Coinsurance
Your percentage share of a covered service after the deductible or other plan rules have been satisfied.
Out-of-Pocket Maximum
The annual ceiling on certain covered cost-sharing, after which the plan usually pays more of the covered expenses for the rest of the plan year.
Network
The doctors, hospitals, and facilities a plan contracts with. Network fit is one of the first things to verify before enrolling.
Formulary
The drug list a plan uses to organize prescriptions into covered tiers, prior-authorization rules, and cost-sharing levels.
Special Enrollment Period
A time outside the standard enrollment window when a qualifying life event may let you enroll in coverage or change plans.
Prior Authorization
A pre-approval requirement for certain drugs, procedures, or services before the plan agrees to cover them under its rules.
HSA-Eligible Plan
A plan design that meets the rules required to pair with a Health Savings Account. Not every high-deductible plan qualifies.
Metal Level
The Marketplace shorthand for Bronze, Silver, Gold, and similar plan groupings that describe how costs are generally shared, not which doctors are included.
Effective Date
The day coverage begins. The date matters because eligibility, premium timing, and prior coverage gaps all connect back to it.
COBRA
A continuation option that can let certain people keep group health coverage for a limited period after a qualifying event such as a job loss or reduction in hours.
Explanation of Benefits (EOB)
A claim summary showing what was billed, what the plan processed, and what responsibility may still remain with the member.
Underwriting
The review process used in some coverage categories to assess eligibility, pricing, or whether a carrier will accept an application.