Glossary

Not sure what a deductible is? Confused about copays? You’re not alone. Health care can be tough to navigate — so we’re here to help. Get to know common health care terms with our deductible plan glossary.


 

Coinsurance

A percentage of cost that you pay for services. For example, if you have 20% coinsurance and get a procedure that costs $100, you’ll pay $20.
 

Copay

A set amount you pay for covered services. For example, when you check in at your doctor’s office, the receptionist might say you owe a $10 copay for that visit.
 

Deductible

The amount you pay for certain services each year before Kaiser Permanente starts paying. You’ll pay the full cost for these services until you reach your deductible. After that, you’ll pay a copay or coinsurance until you reach your out-of-pocket maximum.1,2
 

Explanation of Benefits

A summary of the care you received and what your health plan covers. You’ll receive it after a visit, but it’s not a bill. You can use it to see how close you are to reaching your deductible and out-of-pocket maximum.
 

Flexible spending account (FSA)

An account that lets you put aside tax-free3 money to help pay for qualified health care expenses.4 Most FSAs have a “use it or lose it” policy and won’t roll over any unused money at the end of the year. And if you change jobs or retire, you lose any unused money in your account.
 

Health reimbursement arrangement (HRA)

An account your employer puts money in to help you pay for health care.5 The money isn’t considered part of your wages, so you don’t need to pay taxes on it.3
 

Health savings account (HSA)

An account that lets you put aside tax-free3 money to help pay for qualified medical expenses.4 You can keep the money if you change jobs or retire, and your account can earn interest.
 

Out-of-pocket maximum

The most you’ll pay for covered services each year.1
 

Preventive care

A defined set of services designed to help catch health problems before they get serious — like mammograms, blood pressure screenings, and cholesterol tests. Getting preventive care when you’re healthy can help you stay that way. Contact your benefits administrator to find out which preventive care services your plan covers.


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© 2019 Kaiser Permanente

1For a small number of services, you may need to keep paying copays or coinsurance after reaching your out-of-pocket maximum.
2Your copay experience may vary by region. Check your Evidence of Coverage for more details.
3The tax references on this page relate to federal income tax only. Consult with your financial or tax advisor for information about state income tax laws.
4To view the list of qualified medical expenses defined under Internal Revenue Code Section 213(d), see IRS Publication 502, Medical and Dental Expenses, at irs.gov/publications.
5A qualified health care expense is defined under Internal Revenue Code 213(d). Ask your employer what type of HRA you have to see which of the qualified health care costs described in IRS Publication 502, Medical and Dental Expenses, available at irs.gov/publications, you can pay for using your HRA.