Definitions of Health Care Terms

Children: Dependent children can be covered by a guardian’s insurance plan until they turn 26 years old.

Coinsurance: Your percentage share for certain medical expenses after the deductible is met.

Copay or Copayment: The set dollar amount you pay for certain medical services.

COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows extension of health insurance coverage for defined periods of time at your own expense providing application is made within 60 days of the termination of your appointment.

Deductible: The amount you must pay for services each annual plan year before insurance begins to pay for benefits.

Domestic Partner: Two non-related adults of the same sex, both of whom are at least 18 years of age, are committed as a family in a long-term relationship of indefinite duration and are socially, emotionally, and financially interdependent in an exclusive mutual commitment in which they agree to be responsible for each other’s common welfare and share financial obligations. This definition covers same-sex partner relationships, and not persons who are cohabiting simply as roommates.

Explanation of Benefits (EOB): An itemized statement that describes benefits processed by your insurance once medical services are provided.

Out-of-Pocket Maximum: Since you are responsible for a portion of the cost of your medical expenses, insurance plans include an annual plan year out-of-pocket limit to protect you in the event of high medical bills. After you have paid the out-of-pocket limit insurance covers any additional medical expenses incurred in the same plan year at 100%.

Participating Provider or In-Network Provider: A physician, hospital, lab, etc. who has agreed to accept your insurance plan.

Reasonable & Customary Charges (R&C): This is the usual fee charged by similar providers for the same services or supplies in the same geographic area.

Spouse: One who is married to a student by a ceremony recognized by state law. A husband or wife is a spouse until a court formally decrees the marriage to be dissolved.

Student Health Benefits Plan (SHBP) or WellFleet: The student health insurance program administered through Johns Hopkins University Human Resources.

Student Health & Well-Being (SHWB): A system of care which provides health services to eligible students, house staff, postdoctoral fellows, and trainees of Johns Hopkins University. SHWB includes primary care, mental health, disability, and health promotion services.