Definitions for a number of commonly used terms in health care plans

Updated over a week ago


This term can be applied to many types of organizations. For the purpose of this glossary, administrator refers to the company who administers, your HealthEquity account.

Aggregate deductible

The maximum amount the insured can pay as deductibles over a specified period, typically one year. Offers protection to the insured from a high frequency of losses, sometimes called 'annual aggregate deductible.'


The individual(s) designated to inherit your Health Savings Account (HSA) in the event of your death.


The detailed information about a specific medical service submitted to your insurance company for processing. You can enter new claims records and access existing claims records in the member portal for payment and documentation purposes as needed.


Amounts you pay (as a percentage of cost) after you meet your health plan deductible, but before you meet the out-of-pocket maximum. (i.e., 10%, 20%, etc.)


The technical term used to refer to funds placed into (other than transfers and rollovers) your HealthEquity account.

Contribution limit

The maximum amount established by the IRS that you can contribute to your HealthEquity accounts.


The fixed dollar amount you pay for specified services and prescriptions under most traditional health plans.

Coverage tier

The level of coverage you have (usually single or family). HealthEquity account contribution limits may vary by coverage tier.


The amount you must pay before your health plan begins paying toward your medical costs.


1. Individual other than yourself who is covered by your insurance plan (typically a spouse or child).

2. The IRS has specific requirements to determine tax dependents. Your HealthEquity account can be used to pay the qualified medical expenses of any tax dependent, regardless of whether they are covered by your plan. Consult a tax advisor regarding your specific situation.


An amount taken off the cost of services. For example, your insurance contractually reduces the cost of your medical bill to your service provider.


The technical term used to refer to funds spent from from your HealthEquity account.

Electronic Funds Transfer (EFT)

A method of transferring funds directly between your personal financial institution and your HealthEquity account. You can set up EFT for contributions or distributions in your online account.

Eligible individual

An individual who meets all the IRS requirements to contribute to a HealthEquity account. You can read more about eligible individuals in IRS Publication 969.

Embedded deductible

An insurance plan in which each individual has their own deductible that can be met before their out-of-pocket costs are covered.

Explanation of Benefits (EOB)

A statement from your insurance that shows the service billed from your provider and the deductible, coinsurance, and other covered amounts, as applicable. Compare this to the invoice from your provider to ensure accuracy.

Health Maintenance Organization (HMO)

An HMO avails access to doctors and hospitals, often called a provider or health plan network. A primary care physician (PCP) may be seen for routine check-ups and physicals and will refer you to a specialist within your network for additional services.


A provider that participates in your health plan network who agrees to charge negotiated rates established with your health plan.

Insurance ID card

The card, provided by your health plan, that your provider uses to verify coverage and processes billing of your claim. It is important that you present this card each time you use healthcare services.

Insurance premium

The amount you pay (usually per pay period) to have health insurance. HSA-qualified plans typically have lower premiums than traditional health plans.

Maximum out of pocket

After you pay this amount in a plan year for medical expenses, your health plan will cover all healthcare costs completely.


A provider who does not participate in your health plan network and has no agreement with your health plan. You can still use your HealthEquity account to pay qualified medical expenses incurred at out-of-network providers.

Out-of-pocket maximum

For HSA-qualified plans: The maximum amount you will pay out of pocket, including prescriptions, and your deductible. For other plans: The concept is similar, but copays, coinsurance and other costs may or may not be included in the calculation of your out-of-pocket maximum. Contact your health plan for more details about your specific coverage.


A contract with an insurance company that guarantees you certain coverage for expenses, premium amounts to keep coverage, and rates paid to providers for incurred expenses.

Point of Sale (POS)

The terminal where you make payment with your healthcare account debit card.

Pre-tax benefits

Contributing funds to your HealthEquity account on a pre-tax basis is a benefit that can save you and your employer thousands of dollars over the life of the account on federal and state income taxes.*

Contributing to an HealthEquity account can lower your taxable income, which can help you save money each year when you file your federal and state income taxes. Please see your tax advisor for your State’s specific tax rules related to your HealthEquity account.

Preferred Provider Organization (PPO)

An arrangement in which a health plan contracts with hospitals and doctors to establish a network of participating providers. You generally may pay lower costs when you incur medical expenses within the established network. You can still use your HealthEquity account to pay qualified medical expenses incurred at out-of-network providers.


The amount you pay for health plan insurance coverage (usually monthly).


The doctor or other healthcare professional who provides healthcare services.

Provider invoice (provider statement)

The bill from your provider for services received. It should reflect the adjustments presented on the explanation of benefits (EOB) from your health plan.

Qualified medical expenses

Expenses that can be paid tax free using your HSA.


Money you distribute from your HealthEquity account to pay yourself back for out-of-pocket qualified medical expenses. There is no deadline to reimburse yourself for qualified medical expenses from your HSA; but, there are specific deadlines for reimbursements on your Flexible Spending Account (FSA), Limited Purpose Flexible Spending Account (LPFSA), and Dependent Care Flexible Spending Account (DCFSA) and you should check your plan documents for those details.

*HealthEquity does not provide legal, tax or financial advice. Always consult a professional when making life-changing decisions.

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