Comprehensive Health Insurance Glossary

Children's Health Insurance Program, or CHIP

A program available in all states that provides free or low-cost health care — including dental, vision and prescription drug coverage — for children whose family earns too much money to qualify for Medicaid, but not enough to buy private insurance. In some states the program is available to parents and pregnant women.

Civilian Health and Medical Program of the Department of Veterans Affairs, or CHAMPVA

A comprehensive health care program where the Department of Veterans Affairs, or VA, shares the cost of covered services and supplies with those who are eligible:

A spouse or child of a veteran who is permanently and totally disabled from a service-related incident, as rated by a regional VA office
A surviving spouse or child of a veteran who died from a VA-rated, service-related disability
A surviving spouse or child of a veteran who was permanently and totally disabled from a service-related incident at the time of their death
A surviving spouse or child of a service member who died in the line of duty, not due to misconduct

If you're the spouse or child of a service member who was killed in action, you aren't eligible for CHAMPVA since you can still receive TRICARE benefits.

Visit the VA website for additional eligibility requirements.

Coinsurance

The percentage of charges you're responsible for paying when certain covered services are received, after you've met your deductible. For example, if you have a 20% coinsurance, you'll pay $40 for a covered service that costs $200.

Consolidated Omnibus Budget Reconciliation Act, or COBRA

This is a federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event.

Continued Health Care Benefit Program, or CHCBP

A premium-based plan similar to COBRA that provides health coverage for 18 to 26 months after losing TRICARE eligibility.

Visit the TRICARE website for additional eligibility requirements.

Copay

The amount of money you're required to pay for certain covered services or prescriptions. There may be separate copays for doctor visits, specialists, emergency room care and different levels of prescription drugs.

Cost Sharing

This is the amount of money you'll pay out of pocket for things covered by your plan, including deductibles, coinsurance and copays. It doesn't include premiums.

Cost Sharing Reduction

This is a discount that reduces the total amount you have to pay for deductibles, coinsurance and copays. You may be eligible if your income is below a certain amount and you buy a Silver level plan from the government marketplace.

Deductible

This is the amount you must pay for covered health care services before your health insurance plan starts to pay a portion of the covered charges. Once you've met the deductible, you may have a copay or coinsurance amount for covered services for the rest of the calendar year. Until you meet your deductible, you'll likely pay the full amount for most health services.

Exclusive Provider Organization, or EPO

A type of health insurance plan where services are only covered if you use a doctor, specialist or hospital within the plan's network. Emergency care is generally covered, regardless of where it is received.

Flexible Spending Account, or FSA

A special type of account you can use to pay for health and dependent care expenses, including dental and vision. The money you add to the account isn't taxed as long as it's used for qualified expenses defined by the IRS. The account is owned by your employer and, generally, any money left at the end of the plan year is forfeited.

Formulary

This is a list of medications covered by a prescription drug or other insurance plan that offers prescription drug benefits.

Health Maintenance Organization, or HMO

A type of health insurance plan that limits coverage to care provided by a designated group or network of doctors, hospitals, labs and other providers who work for or contract with the HMO. You may be required to live or work in an HMO's service area to be eligible for coverage. You must select a primary care physician and seek care from that physician first, unless you receive a referral. HMOs generally won't cover out-of-network care, except in an emergency.

Health Savings Account, or HSA

A special type of savings account you can use on a basis to pay for health care expenses, including dental and vision. The money you add to the account isn't taxed as long as it's used for qualified expenses defined by the IRS. In 2025, your health insurance plan deductible has to be at least $1,650 for an individual and $3,300 for a family in order to be eligible for an HSA. Unlike an FSA, the money in this type of account stays with you even if you change jobs or retire.

Medicaid

This is a joint federal/state program available in all states that offers free or low-cost health care for low-income people, families, children, pregnant women, elderly and people with disabilities. In some states, the program is available to all adults who fall below a certain income level. All Medicaid programs follow federal guidelines, but coverage, costs and procedures vary by state.

Minimum Essential Coverage

This is a health insurance plan that meets the Affordable Care Act's health coverage requirement. Plans that qualify as minimum essential coverage include marketplace plans, employer-sponsored plans, Medicare, Medicaid, CHIP and TRICARE.

Network

This is a designated group of health care providers, facilities and suppliers your insurer or plan has contracted with to provide health care services.

Out-of-Pocket Maximum

The amount of money you need to pay during a policy period before your health insurance plan starts to pay for 100% of covered essential benefits. This includes your deductible, coinsurance, copays and similar charges — but not your monthly premium. For the 2025 plan year, the out-of-pocket maximum on an Affordable Care Act, or ACA, compliant health plan is no more than $9,200 for an individual and $18,400 for a family.

Point of Service

A type of health insurance plan where you pay less if you use doctors, specialists and hospitals within the plan's network. A referral from a primary care physician is usually required to see a specialist.

Preferred Provider Organization, or PPO

A type of health insurance plan that offers covered health care services for less if you use doctors, specialists and hospitals within the plan's network. You can choose from in-network providers without selecting a primary care physician and a referral is not required to see another physician. If you use health care providers outside your network, you can expect to pay higher costs.

Premium

The cost to keep your health insurance plan active. Premiums are usually paid monthly, quarterly or yearly.

Preventive Care

This is a routine care, such as an annual physical, intended to assess your health and help keep you healthy. A service is considered preventive if there are no signs of illness and no indication that diagnostic services or treatment are needed.

Primary Care Provider, or PCP

A physician, nurse practitioner, clinical nurse specialist or physician assistant who provides, coordinates or helps a patient access a range of health care services.

Qualified Medical Expense

This is a medical or dental expense that can be deducted from your taxes, as defined by the IRS.

Transitional Assistance Management Program, or TAMP

Provides six months of premium-free health insurance coverage to service members who are separating from the military. Visit the TRICARE website for additional eligibility requirements.

TRICARE Reserve Select

This is a health insurance plan available to the guard and reserve members:

Not on active duty.
Not covered under the Transitional Assistance Management Program.
Not eligible for, enrolled in or covered by the Federal Employees Health Benefits, or FEHB, program, either on their own or through a family member.