​Allowed Amount: The maximum amount your plan will pay for a covered health care service. 

Balance Billing: An in-network healthcare provider gets paid the insurance company’s allowed amount. An out-of-network provider may not accept this amount as payment in full, and may charge you the difference.  This is known as balance billing. 

Coinsurance: A percentage of the allowed amount you may be responsible for  after you have paid your deductible. 

Copay: This is a set dollar amount that you must pay for a particular service. 

Deductible: The money you have to pay for your healthcare before your insurance starts covering the costs. 

In-Network Provider: Providers that are contracted with your insurance company. Services received from an in-network provider usually only require you to pay your deductible and any copay or coinsurance.

Mental Health Parity: Health plans cannot impose barriers to your access to mental health or substance use services that are not also applied to your access to medical or surgical services. 

Out-of-Network Provider: When using an out-of-network provider, you are responsible for out-of-network cost sharing: your copay or coinsurance may be more and you may be subject to balance billing. 

Out-of-Pocket Expenses: Money you pay for your health care. This includes deductibles, coinsurance, copayments, and similar charges. Your premium is not considered part of out-of-pocket expenses. 

Out-of-Pocket Maximum: The maximum amount that you pay before your insurance will pay the full allowable amount.

Get free help with your health coverage! ​

The Maryland Insurance Administration has a Health Coverage Assistance Team (H-CAT) to assist consumers. If you have questions or concerns about health coverage for you or your loved ones, the H-CAT staff is here for you. 

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