Aetna Insurance Definitions

The definitions provided below  include some of the most common insurance terms for the Aetna insurance plan. For a full list of definitions, review the Aetna Student Health insurance glossary.

Benefit Period: The maximum length of time for which benefits will be paid.

Copay: The specific dollar amount or percentage that the member must pay, or that must be paid on behalf of a member, when covered services are provided.

Deductible: An amount of money that a member must pay for covered services, including prescription drugs, in a specified time period, before the plan will pay benefits.

In-Network: Refers to the use of health care professionals who participate in the health plan’s provider and hospital network.

Nonparticipating Provider (also known as Out-of-Network or Nonpreferred Care Provider): Generally used to mean health care professionals – like doctors – and hospitals that have not contracted with a health plan to provide services at reduced fees. *Aetna does not credential, monitor or oversee those providers who participate through third-party contracts. Since there are a number of factors that determine whether a discount will be given, Aetna is unable to guarantee any level of discount under this program.

Out-of-Pocket Maximum: The highest amount a health plan member is required to pay for covered services outside of his/her benefits plan. Once the member reaches the out-of-pocket maximum(s), the plan pays 100% of expenses for covered services.

Participating Provider (also known as Preferred Care Provider): Any doctor, hospital, skilled nursing facility, other individual or entity involved in the delivery of health care or related services that contracts to provide covered services to members for a negotiated charge.

Premium: The fee or charges incurred to receive coverage by an insurance company or carrier.

Provider Network: Doctors, hospitals and other health care providers who have a contract with a health insurance/health benefits company to provide services at a negotiated rate of repayment.

Insurance Office

Hours: Monday – Thursday 8:30 – 4:30pm, Friday 12:30 – 4:30pm

Phone: (703) 993-2827 or (703) 993-7634


Fax: 703-993-3955

Address: Student Union Building (SUB) I, Rooms 2345 & 2349

4400 University Drive, MS 2D3, Fairfax VA, 22030