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Glossary of Common Health Insurance Terms

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Out-of-Plan

This phrase usually refers to physicians, hospitals, or other health care providers whom are considered nonparticipants in an insurance plan (usually an HMO or PPO). Depending on an individual’s health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered only in part by an individual’s insurance company.

Out-of-Pocket

A predetermined, limited amount of money that an individual must pay out of their own savings, before an insurance company (or self-insured employer) will pay 100 percent for an individual's health care expenses.
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