Health Insurance

35 Pre-existing condition —A health condition you had before you joined a group plan or applied for individual insurance. Most policies are prohibited from denying coverage because you have a pre-existing condition. See pages 8, 11, 16 and 29. Premium —The fee you pay to have insurance. Your employer may pay part of your premium. The premium is usually paid monthly. Provider —A health professional or organization that provides health care services, such as a doctor, physical therapist, hospital, lab, or clinic. A preferred provider is a provider in your plan’s network. Tiered network —A kind of medical provider network with several cost levels. You pay different amounts to see providers in different tiers. UCR (usual, customary, and reasonable) —The amount that providers in an area usually charge for the same or similar service. The allowed amount may be based on the UCR amount.