Private Health Insurance

Casual users say out-of-pocket costs, but insiders use cost share to refer specifically to insured members' financial responsibility alongside insurer payments.

Casual observers call the regular payment a premium, but insiders often specify GWP to denote total premiums underwritten before deductions.

Outsiders refer broadly to the health insurance market, whereas insiders segment it specifically into group or individual markets defining client categories and regulatory frameworks.

The general public says insurance company, while industry professionals more frequently use 'insurer' or 'carrier' reflecting formal entities underwriting risks.

While outsiders say 'claim' for any request for payment, insiders next use 'Notice of Loss' for the initial formal reporting event triggering underwriting processes.

Outsiders refer to the contract broadly as a health insurance policy, whereas insiders use 'plan document' to emphasize the detailed legal and technical content governing coverage.

Outside the industry, a 'network' is a familiar concept of providers, but insiders often refer to a 'provider panel' denoting the curated group contracted for services.

Both terms refer to amounts paid by insureds before coverage applies, but insiders use 'retention' particularly in reinsurance and risk sharing contexts.

Outsiders mention pre-existing conditions broadly, while insiders classify these medically relevant factors under underwriting risk to determine coverage eligibility and pricing.

While outsiders recognize managed care as a health plan model, insiders focus on UM as a set of processes controlling service appropriateness and cost-effectiveness.