| Code | Display | Definition |
| allowed | Allowed | The maximum amount a plan will pay for a covered health care service. May also be called \"payment allowance\", or \"negotiated rate\". |
| coinsurance | Co-Insurance | The amount the insured individual pays, as a set percentage of the cost of covered services, as an out-of-pocket payment to the provider. Example: Insured pays 20% and the insurer pays 80%. |
| copay | CoPay | A fixed amount ($20, for example) the insured individual pays for a covered health care service after the deductible is paid. |
| deductible | Deductible | The amount the insured individual pays for covered health care services before the insurance plan starts to pay. |
| eligible | Eligible Amount | Amount of the charge which is considered for adjudication. |
| memberliability | Member Liability | The amount of the member's liability. |
| noncovered | Noncovered | The portion of the cost of the service that was deemed not eligible by the insurer because the service or member was not covered by the subscriber contract. |
| out-of-pocket-maximum | Out-of-Pocket Maximum | The most the insured individual has to pay for covered services in a plan year. After this amount is spent on deductibles, copayments, and coinsurance for in-network care and services, the health plan pays 100% of the costs of covered benefits. |
| visit | Visit | A medical visit means diagnostic, therapeutic, or consultative services provided to a client by a healthcare professional in an outpatient setting. |
| penalty | Penalty | Benefit penalty is an approach used by the insurance company to reduce their payment on a claim when the patient or medical provider does not satisfy the rules of the health plan. Benefit penalties may occur when a pre-authorization is not obtained, for example. |