We want you to use it often, so you can become familiar with some of the words youll hear when you get medical. For example, if your health insurance plan covers 80% of the allowable charge for a specific service, you may be required to pay the remaining 20% as coinsurance. You select a primary care doctor who coordinates all of your medical care including referrals to a specialist and hospital care, if necessary. Some of these words are common with many types of insurance. A licensed practitioner providing medical expertise and services within the scope of his or her license and practice. Health insurance glossary page access your availability to medical care which is determined by where you live and the type of health care facilities available in your area. Insurance holding company system consists of two or more affiliated persons, one or more of which is an insurer. View the expanded gerber life glossary of life insurance terms here. An individual designated by a policy holder to receive the benefits of an insurance policy. Congressional research service 1 introduction congress has seen a renewed interest in questions related to the market for private health insurance since the passage of the patient protection and affordable care act aca.
Health maintenance organizations hmos hmos emphasize prevention and offer a select choice of doctors and hospitals. Health services provided to members who are not confirmed to a health care institution. Insurance regulatory information system iris a baseline solvency screening system for the national association of insurance commissioners naic and state insurance regulators established in the mid1970s. This glossary explains what the words and phrases mean for health insurance. Glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. You have another option, which is commonly called traditional, indemnity or feeforservice insurance, as well.
Health insurance glossary understanding healthcare terms. A provision in an insurance policy that states that the validity of the insurance contract cannot be contested after two or sometimes three years. Glossary of medical insurance terminology pdf uc merced. This term may be used to describe ancillary products purchased in conjunction with a medical insurance plan. Some health insurance companies may use some words with a diffferent meaning from those given in this health insurance glossary, and practices may vary among health insurance companies. The insurance premium is what subscribers andor employers pay to the insurance company for the coverage. The type of health insurance in which we are usually interested is. Common terms used in health insurance small business health insurance plan resources in illinois. Glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. Health insurance glossary of terms admitting privileges. Different health insurance policies can offer different benefits, and some can limit which doctors, hospitals, or other providers you can use. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law.
Medical insurance glossary of terms health medicare pdfs. A description of the healthcare services and supplies that a health insurance company covers for members of a specific health insurance plan. Any activity done to help a person or group get something the person or group wants or needs. The fee you pay for certain medical services or for each prescription. The money the insurance company pays the health care provider for medical services provided to you if you become ill or injured.
Serving maryland, the district of columbia and portions of virginia, carefirst bluecross blueshield is the shared business name of carefirst of maryland, inc. Annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. Glossary of health coverage and medical terms page 1 of 4 glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. Word description ten day free look a notice on the first page of health insurance policies that the insured has ten days in which to examine the policy and return it for a refund of premium if he is not satisfied with the policy. Anyone covered under your health plan that is not named as insured in your documentation from the insurance company. This glossary defines commonly used health insurance and health care terms. Glossary of health insurance terms blue cross and blue shield of. A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of patient care. When you assign benefits, you sign a document allowing your. Allowed amount the highest amount we will cover pay for a service. The ability of a doctor to admit a patient to a particular hospital. Definitions of health insurance terms in february 2002, the federal governments interdepartmental committee on employmentbased health insurance surveys approved the following set of definitions for use in federal surveys collecting employerbased health insurance data. Health insurance glossary carefirst bluecross blueshield. This limit must include deductibles, co insurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the health benefits.
Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. Health insurance glossary understanding health care. Glossary of health insurance terms skip secondary navigation ribbons. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Together, we created this glossary of key health insurance terms. View the carefirst health insurance glossary, containing helpful definitions that clarify terms or questions related to your health insurance plan. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Health maintenance organization hmo a health care system that assumes both the financial risks associated with providing comprehensive medical services insurance and service risk and the responsibility for health care delivery in a particular geographic area to hmo members, usually in return for a fixed, prepaid fee. If your plan has a 20% coinsurance, your insurance may pay 80% of the cost and you might pay 20%. This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. Maximum amount paid per year for specific or total medical services. Glossary of healthcare terms health insurance and reform. When making decisions about health coverage, consumers should know the specific meanings of terms used to.
The annual cycle in which a health insurance plan operates. The type of health insurance in which we are usually interested is comprehensive or major medical policies. Find understandable and helpful definitions for common health insurance and healthcare terms in medical mutuals health insurance glossary. A guide to dental ppos, hmos and other managed plans, don mayes, revised edition, 2002.
Health insurance 101 words to know when you need medical care 00. Health insurance and obamacare terms what does health reform mean to you. Benefit period when services are covered under your plan. The health insurance or plan pays the rest of the allowed amount. This health insurance glossary is not exhaustive and may not be accurate because usage of terms can vary. Also called feeforservice plans, indemnity plans typically allow you to direct your own health care and visit whatever doctors or hospitals you like. Bold text indicates a term defined in this glossary. Glossary of medical insurance terminology page 1 annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. If this health insurance glossary doesnt help, please feel free to contact us with your questions a accident. Well give you an assist by helping you learn the language of health insurance. Compare plans side by side, get health insurance quotes, apply online and find affordable health insurance today. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher. Congressional research service 1 introduction congress has seen a renewed interest in questions related to the market for private health insurance since the passage of the patient protection and.
Consumer glossary national association of insurance. Do you have a spouse or children who you want to provide for in life and in death. Glossary of healthcare terms health insurance and reform accountable care organization aco. Adjusted community rating means that the rates charged by insurance companies may vary by one or more variables such as age, gender, or health status. A claim is a request by an individual or his or her provider to an individuals insurance company for the insurance company to pay for.
Health insurance glossary health insurance definitions. Here is some of the basic terminology for life insurance. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. This glossary has many commonly used terms, but isnt a full list. These glossary terms and definitions are intended to be educational and may be different from the terms. The charges agreed to by the preferred provider organization ppo for specified covered medical treatment, services and supplies. Glossary of dental insurance and dental care terms.
An unforeseen and unintentional act identifiable in time and place. The term health insurance covers a wide range of policies that cover the costs of doctors and hospitals and those that meet specific needs, such as paying for longterm care. Glossary of health insurance terms december 12, 2008 broker a salesperson who has obtained a state license to sell and service con tracts of multiple health plans or insurers, and who is considered to be an agent of. An individual plan can cover you andor any of your eligible family members. Accident for the purposes of health insurance, an accident is an unforeseen, unexpected and unintended event resulting in a bodily injury. The three most common managed health insurance plan choices are. Insured the persons covered by the insurance policy. When doctors or hospitals bill patients directly for care above what the insurer pays, it is known as balance billing. Health insurance glossary and key terms health insurance policies can get confusing fast. That would leave patients responsible for the balance due. Amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss.
Health insurance glossary understanding health care terms. This is the share of the cost you pay for health care received after you meet your deductible. Ambulatory services health services provided to members who are not confined to a health care institution. Often, associations can offer individual health insurance plans specially designed for their members. The uniform glossary includes many commonly used health coverage and medical terms, but isnt a full list. It discloses what is covered, what is not, and dollar limits. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance. A device that has a chamber where instruments are placed and steam under pressure is injected, in order to complete sterilization. See if you qualify for a special enrollment period. Health insurance glossary health insurance definitions and. While every effort is made to ensure that this information is accurate and current, scai. You may have to pay a deductible each plan year before your insurance company starts to pay for your care. A health insurance policy you buy directly from a health insurance company or broker rather than through an employer.
Glossary of health insurance and medical terms page 1 of 4 glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. An insurance plan thats certified by the health insurance marketplace, provides essential health benefits, follows established limits on costsharing like deductibles, copayments, and outofpocket maximum amounts, and meets other requirements under the affordable care act. Coinsurance a form of medical cost sharing in a health insurance plan that. The most you pay during a policy period usually a calendar year before your health insurance or plan starts to pay 100% for covered health benefits. Those can be found in your insurance policy or certificate. Health insurance glossary of terms health coverage fast blog. Glossary of health coverage and medical terms just plain clear. Some of these terms also might not have exactly the same meaning when. But once you meet your outofpocket maximum, your insurance pays 100% of qualifying costs. To help you better understand health insurance, heres a list of the most. Health insurance is full of terms you may not know.
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