Casualty Liability or loss resulting from an accident. Formulary (also known as drug or formulary list). Insurance is an intricate product and so is its glossary. The amount can vary by the type of service. (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
Chapter 20 Basics of Health Insurance 45 Terms. Co-Insurance. Healthcare services are defined as medically necessary (or to have medical necessity) if a doctor would normally provide those services to a patient for the purpose of evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and if they are: Medication Discount Card (also known as prescription or drug discount card). The Health Insurance Marketplace, or Health Insurance Exchange, is a federal government website where you can shop, compare and buy plans offered by participating health insurance companies in your area. HMOs require the use of specific, in-network plan providers. Shopping for a health insurance plan can be overwhelming, especially if you aren’t familiar with some of the more common health insurance terms. While these terms can be confusing, the better you understand them, the better you will be prepared to successfully gain coverage and access to the treatments that are right for you. 2. of . Medicaid: Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Did we miss something? The amount you pay monthly for your health insurance … HDHPs are often paired with a health savings account (HSA), which allows you to pay for certain medical expenses with money exempt from federal taxes. Health care services that help a person keep, learn or improve skills and functioning for daily living. Insurance company that actually underwrites and issues the insurance policy. Copaymentâone of the ways you share in your medical costs. Beneficiary: An individual designated by a policy holder to receive the benefits of an insurance policy. Examples of out-of-pocket costs include co-payments, coinsurance and deductibles. Glossary of billing and insurance terms. Underwritingâthe process by which health insurance companies determine whether to extend coverage to an applicant and/or set the policy's premium. It is an insured person’s protection cover over his/her family; it secures the family financially if the insured is no more. This number is used to track services and payments. Endorsement Amendment to the policy used to add or delete coverage. Insurance terms 42 Terms. Medication discount cards are one way to help lower your prescription medication costs. Español. It provides free or heavily cost-reduced health care to eligible enrollees. Taking the time to understand what they are trying to say makes it easier to communicate, though, and ultimately saves my time by avoiding confusion between me, my doctor and my insurance company.”—T1D patient, NY. Long-term Insurance - A type of health insurance that covers certain services over a set amount of time (typically a 12-month period). Health policies can offer many options and vary in their approaches to coverage. nitazag. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation's health insurance companies, including Aetna and Blue Cross Blue Shield . Benefit: Amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss. A high-deductible health plan (HDHP) is a type of insurance plan with a higher deductible than traditional insurance plans. Generics come to the market after a brand-name medicine’s patents expire, and they usually cost less. In an HMO, you are almost always required to see a primary care doctor first and get a referral before you can see a specialist. The monthly premium is usually lower, but you pay more of the healthcare costs when you seek care before your deductible is met. Wisconsin Physicians Service®. 1. Wisconsin Office of the Commissioner of Insurance, About | Careers | Privacy Policy | Terms and Conditions | Code of Conduct | Supplier Code of Conduct | Notice of Privacy Practices, Español | Hmoob | ç¹é«ä¸æ íêµì´ | Deutsch | اÙعربÙØ© | Ð ÑÑÑкий | Tiếng Viá»t | Deitsch | àºàº²àºªàº²àº¥àº²àº§ | Français | Polski | हिà¤à¤¦à¥ | Shqip | Tagalog |
Policy documents contain a number of insurance terms because they typically define the limitations of risk and liability on the insured and any exclusions of coverage. Coordination of benefitsâa system used in group health plans to eliminate duplication of benefits when you are covered under more than one group plan. An out-of-pocket maximum is the total amount you will pay before your health insurance begins to pay 100 percent of the cost for in-network services. Additional health insurance products (such as vision or dental insurance) that may be added to a medical insurance plan for an additional fee. Effective dateâthe date on which a policyholder's coverage begins. Helping millions of Americans since 1994. smoser3838; Subjects. When an insurance company is deciding whether to cover a medication or service, it considers whether that service is medically necessary. Clinical studies, or trials, are part of the process by which new therapies receive approval by the FDA. Health savings account (HSA)âa personal savings account that allows participants to pay for medical expenses with pre-tax dollars. NCCT Insurance 63 Terms. And now, some basic terms: Allowable charge —sometimes known as the "allowed amount," "maximum allowable," and "usual, customary, and reasonable (UCR)" charge, this is the dollar amount considered by a health insurance company to be a reasonable charge for medical services or supplies based on the rates in your area. Arts and Humanities. A flexible spending account (FSA) is a special type of account used to pay for health expenses. The IRS has a list of allowable expenses that HSA funds can be used for, so make sure to check that before using your funds. 2. of . This is any private health insurance plan held by a Medicare or commercial beneficiary, including Medigap policies or post-retirement benefits. Also referred to as a "rider." Medicaid is funded by the federal and state governments, and managed by the states. A Health Maintenance Organization (HMO) is the type of insurance plan with the most restricted provider network. We value your privacy. Managed care – a term used to describe health insurance plans that tend to cost less because costs are controlled by offering a limited number of healthcare providers and facilities, usually referred to as the network. Group health insuranceâa coverage plan offered by an employer or other organization that covers the individuals in that group and their dependents under a single policy. Individual health insuranceâhealth insurance plans purchased by individuals to cover themselves and their families. Then, you’ll calculate the percentage of that total cost to determine how much you’re responsible for paying. Take a deep breath with us, and let's dive in. The U.S. Food and Drug Administration (FDA) rates these to be as safe and effective as brand-name medications. Health Insurance Marketplace. It includes but is not limited to states variously described as; abnormality, ailment, disability, disease, disorder, health problem, illness, impairment, impediment, infirmity, injury, malady, sickness or unwellness. A. Disease Management Program: A program offered by a health insurance company to manage the costs of policyholders’ chronic health conditions. To calculate coinsurance for a service, you’ll need to know how much in total you will be charged for the service. There can be limits on how much a patient is responsible for paying out-of-pocket, determined by each insurer. Standard Definitions of terminology used in Health Insurance Policies. email support; call (800) 314-5594; Glossary. Accelerated death benefits – This policy provision may be available with a life insurance policy to allow you to get your death benefit while you’re alive if you’re diagnosed with a serious illness or need help with activities of daily living. A complaint that you communicate to your health insurer or plan. Many of the terms you encounter when dealing with health insurance are not familiar. Health Insurance Glossary FAQ Index. Out-of-pocket maximumâthe most money you will pay during a year for coverage. var dteNow = new Date();
An Exclusive Provider Organization (EPO) is a type of insurance plan with fewer providers to choose from. It stands for the C onsolidated O mnibus B udget R econciliation A ct of 1985, which is the law that first introduced COBRA insurance. Most health insurance plans don’t pay for long-term care. We think you'll agree that a little knowledge will go a long way toward helping you make sense of it allâso you can make smart decisions that will benefit you and your family, today and for years to come. smoser3838. Higher tiers cover preferred and non-preferred brand-name medications at a higher cost to you. You will usually see a note of what the allowed amount/allowed charge is on the explanation of benefits you receive from your insurance company, and it typically comes after the amount that the provider bills (which is their non-negotiated rate). Also, some services, including preventive services, may be covered before you spend the deductible amount. Any injury inflicted as a result of unintentional, unexpected actions or events that require treatment by a registered medical practitioner. Medicare has two parts; Part A, which covers hospital services, and Part B, which covers doctor services. These seven definitions will help you gain a better understanding of basic health insurance terminology. You must use the funds in the FSA during the calendar year (some employers allow you to use a previous years funds through March of the following year), or you will lose the funds. '&l='+l:'';j.async=true;j.src=
Any additional costs that are not covered by insurance when you visit your doctor, hospital or pharmacy are out-of-pocket costs. OTHER SETS BY THIS CREATOR. Here you will find some key insurance terms and definitions. You decide how much you will contribute at the beginning of the year and cannot change it thereafter. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation's health insurance companies, including Aetna and Blue Cross Blue Shield.Compare plans side by side, get health insurance quotes, apply online and find affordable health insurance today. Glossary of Health Coverage and Medical Terms. Use this search for individual and group HMO or POS plans. 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
Also, if you need more information about other types of insurance, check out our resources for homeowners, auto and life insurance. document.write(intYear);
Premiumâthe amount you or your employer pays each month in exchange for insurance coverage. Health Insurance Terms Glossary. Habilitation Services. The Affordable Care Act requires certain health plans for individuals and … An exception request is a written request that your health insurance company cover the medication, device or service you need as advised by your doctor. Major medical health insurance is a type of health insurance that covers the expenses associated with serious illness or hospitalization. A benefit in addition to the face amount of a life insurance policy, payable … The money in an FSA is front-loaded, meaning you may use the full amount immediately at the beginning of the year, even though the full amount has not yet been withheld from your paycheck. Find affordable health plans. Coinsurance - A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid. A generic medication is a prescription medication that has the same active-ingredient formula as a brand-name medication. Your health insurer or plan pays the rest of the allowed amount. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance. We've selected 25 terms that should be in everyone's health insurance tool kit; scroll down to find our complete list of 101 health insurance terms. An HMO insurance plan may not cover your medical costs if you see a doctor who is out-of-network. Medicare. Depending on your plan, your portion of the co-insurance could range from 10-40%. When speaking with prospective clients, oftentimes there is confusion as to the meaning of certain insurance terms. Inpatient care tends to be directed toward more serious ailments and trauma that require one or more days of overnight stay at a hospital. For example, if your plan has coinsurance of 20 percent and you have met your deductible, a medical service that costs $1,000 will require you to pay $200. To help you feel more confident choosing a health plan, this section breaks down some of the most common health insurance terms. Dependentâany individual, either spouse or child, that is covered by the primary insured customerâs plan. Once you’ve met your deductible, your insurance company will be responsible for payment of the remaining medical services. Can include losses due to fire, burglary, vandalism, earthquake, and other perils. Health Insurance Glossary. This is an advertisement for insurance. HDHPs typically offer lower monthly premiums than traditional health plans. Accident “Accident” means an unexpected, unforeseen and undesirable event, especially one resulting in bodily injury. 340B PROGRAM. Payerâthe health insurance company whose plan pays to help cover the cost of your care. Get a free short term health insurance quote Start Now. The definitions in this section were developed by JDRF based on various insurance references and represent the common or general use of the term. And some health insurance plans will not pay at all for out-of-network services. Understanding the meanings of these concepts will help equip you to better address any barriers and make smart decisions that will benefit you and your family. Common forms of cost-sharing include deductibles, coinsurance, and co-payments. The policies, which usually range from one to six months, provide security in case of a health crisis when there would otherwise be a gap in coverage. This excludes accidental illness, surgical procedures, pregnancy, injury or illnesses induced by alcohol or drug dependence and aggravation of a pre-existing condition. For example, if your deductible is $1,000, your plan won’t pay anything in a given year until you’ve spent $1,000 on covered medical services, devices or medications. Before a health insurance company will agree to cover some services, it may require patients to seek approval or permission. Health insurance. It limits rules a group health plan can place on benefits for pre-existing health problems. You can choose your primary care doctor or a specialist you want to see from a smaller list than one found in a PPO [See Preferred Provider Organization (PPO), below] network. If you have health insurance, you pay a flat amount each month called your premium. An exception request should be received before the medication, device or service has been obtained. Explanation of benefitsâthe health insurance company's written explanation of how a medical claim was paid.