Learning the Language of Health Insurance

Health Insurance. It can be intimidating. It’s an important part of life, but it can be so complex. That’s why at Nayya, we always try to help. Our software simplifies finding insurance, and understanding key terms is the first step. Here are some terms you should know when dealing with health insurance. 


Allowed Amount: The monetary amount, determined by the health plan, that is appropriate for a service. 

Coinsurance: The amount (in percentage) that you are required to pay for covered services.

Copay: A flat-fee that you pay for a service. For instance, your copay for every time you visit the doctor’s office may be 15 dollars. 

Deductible: The amount you have to pay each year before your insurance plan starts to pay. So if your deductible is 5,000 dollars, you have to pay 5,000 dollars before your plan will cover your expenses. 

Formulary: The list of drugs that is covered by your plan. Those covered will be cheaper than if you buy some that are not covered by your plan.

Member Responsibility: The amount of the total charge for services received that the member is responsible for. 

Network: The health care professionals that are under contract with your health insurance provider. You usually want to go to someone who is “in-network” because the expenses will be covered by your insurance plan and if you spent money with a professional that is not “in-network” it will not count towards your deductible. 

Out-of-pocket Maximum: The most amount of money you could pay each year for the services that you received. 

Subscriber: The person whose health plan is provided by their employment. They are also responsible for payment of premiums.


If you ever have any other questions, feel free to reach out to team@nayya.com !