Insurance Jargon Translator

Insurance Jargon

Keep Your Head From Spinning

Insurance Translator

[pree-mee-uhm] (noun)

monthly fee paid to an insurance company or health plan to provide health coverage.

[ dih-duhk-tuh-buhl ] (noun)

A specified amount or capped limit you must pay first before your insurance will begin paying your medical costs.

[ koh-pey ] (noun)

A flat fee that you pay when you receive specific health care services, such as a doctor visit or getting prescription drugs.

[ koh-in-shooruhns, –shur– ] (noun)

The percentage of a medical bill that you may be responsible for paying after reaching your deductible.


The set amount of money you will have to pay in a year on covered medical costs

[ net-wurk ] (noun)

A list of the doctors, other health care providers, and hospitals that a plan has contracted with to provide medical care to its members.

[ fawr-myuh-ler-ee ] (noun)

A list of generic and brand name prescription drugs covered by your health plan. Your health plan may only help you pay for the drugs listed on its formulary.

A tax-advantaged account to help people save for medical expenses that high-deductible health plans do not cover.  The funds contributed to an account are not subject to federal income tax at the time of deposit.

A set of ten benefits, defined under the Affordable Care Act of 2010, that must be covered by individually-purchased health insurance.

What does essential health mean?

Minimum essential coverage is health insurance coverage that satisfies the Affordable Care Act‘s guidelines. Although there is no longer a federal penalty for not having minimum essential coverage, the individual mandate still exists and the concept of minimum essential coverage is still important.


Plans that qualify as minimum essential coverage include employer-sponsored plans, individual major medical plans (including new ACA-compliant plans, grandfathered plans, TRICARE, Medicare, most Medicaid plans, and a few others.

Essential Health Benefits

Key Benefits of Essential Health Services The Affordable Care Act (ACA), enacted in 2010, brought significant changes to the healthcare landscape in the United States. Designed

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What is MNsure

Options When Shopping for Health Insurance Understanding health insurance can be overwhelming, like dealing with a constantly changing live animal. It has its own set

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10 Essential Health Benefits

  • Ambulatory Services

  • Emergency Services

  • Hospitalization

  • Pregnancy

  • Mental Health

  • Prescription Drugs

  • Rehabilitation

  • Lab Services

  • Preventative

  • Pediatric

Preventive Care... What does that mean?

Preventative care is health care that prevents disease, injury, or illness, rather than treating a condition that has already become catastrophic or acute. The goal of preventive care is to help people stay healthy.

Preventive care can be different based on age and gender. To see a full list of preventive care we have included a helpful link below.  To see if a service you are inquiring about is considered preventive, check out our link below!

Enrolling In A Plan

Open Enrollment

Open Enrollment is a specific timeframe every calendar year when you can sign up for health insurance.


If you do not sign up for health insurance during open enrollment, you typically cannot sign up for insurance until the next open enrollment period, unless you what’s called a qualifying event.

Special Enrollment Period

Special Enrollment Periods, also known as a Qualifying Life Event – are an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual open enrollment period. 


Examples of Qualifying Life Events Include:

  • Losing health insurance for any reason except not paying premiums
  • Losing eligibility (Medicaid, or a Children’s Health Insurance Program)
  • Turning 26 and losing coverage through a parent’s plan.
  • Loss of job-based coverage (quit or fired)
  • Marriage, divorce, or legal separation
  • Pregnancy, adoption of a child, or any adding of dependents.
  • Losing coverage due to a death in the family
  • Moving to a different coverage area.
  • Changes in income that affect the coverage you qualify for.
  • Becoming a US Citizen
  • Released from incarceration
  • Losing coverage due to your spouse retiring.

Metal Teirs


  • 20% Consumer
  • 80% Insurer


  • 30% Consumer
  • 70% Insurer


  • 40% Consumer
  • 60% Insurer

Metal tiers are a quick way to categorize plans based on what that split is. Some people get confused because they think metal tiers describe the quality of the plan or the quality of the service they will receive, which is not true.


Advanced Premium Tax Credit (APTC)

The advanced premium tax credit reduces the amount you pay for monthly health insurance premiums if you bought your insurance on the Marketplace. The amount of the credit is determined by your income. It is calculated and sent directly from the federal government to insurance companies.

What The Heck Is MNsure?

MNsure is Minnesota’s health insurance marketplace where individuals and families can shop, compare, and choose health insurance coverage that meets their needs. MNsure is the only place you can apply for financial help to lower the cost of your monthly insurance premium and out-of-pocket costs.