Here is a glossary to the terms in a health insurance policy.
Benefit exclusion and benefit exhaustion are the most commonly confused terms. Exclusion means the benefits that are not covered by your policy, whereas exhaustion means the benefits that have been used up. Coinsurance means the policy provides only partial reimbursement to the holder and the rest has to paid from his pocket. It is similar to Copay.
Rates fixed by the the CMS for various procedures and health facilities is known as CMS rates. Value network, In-network and Out-of-network are other terms used to describe the type of medical service providers that come under the CMS list of health care providers in the State of New Jersey.