Refers to a broad and constantly changing array of health plans that attempt to manage. Your share of the costs of a covered health care service, calculated as a. Deductible the amount of money the policyholder must pay on a loss. We define these terms so you can continue making wellinformed decisions regarding your healthcare. The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. This glossary defines many commonly used terms, but isnt a full list. The deductible, quoted in whole dollar amounts is the amount a policyholder is responsible for before the insurance policy begins covering any costs. 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.
Ambulatory services health services provided to members who are not confined to a health care institution. Urgent care provider a provider of services for health problems that need medical help right away but are not emergency medical conditions. Abortion services accountable care organization accreditation actuarial value adjusted gross income agi advance premium tax credit. The defined terms and coverage provisions in your policy or certificate of insurance, such as reasonable and customary, may be different from the general information provided below, and the policy or certificate language will prevail. All public health insurance programs, such as medical or covered ca define eligibility income limits as some percentage of fpl. A complaint that you communicate to your health insurer or plan. Shortterm insurance a type of health insurance that covers certain services for a set time period 6 months or less. Check out our health insurance glossary full of information and terms commonly used in the health industry. Health care services that your health insurance or plan doesnt pay for or cover. Health insurance glossary check out the most important words and phrases of health insurance and medical terms and know more about health insurance terms, abbreviations, and acronyms. Glossary of health insurance terms blue cross and blue shield of.
A health insurance contract may also be called a policy or plan. Annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. Jan 17, 2018 definitions do not pre empt definitions in state law or definitions in a health plan or health insurance policy. If you dont have minimum essential coverage, you may have to pay a penalty when you file your federal income tax return unless you qualify for a health coverage. But once you meet your out of pocket maximum, your insurance pays 100% of qualifying costs. The date health insurance coverage begins per the terms of the policy. If your plan has a 20% coinsurance, your insurance may pay 80% of the cost and you might pay 20%.
A contract that requires a health insurer to pay some or all of your health care costs in exchange for a premium. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. This is the share of the cost you pay for health care received after you meet your deductible. A preferred provider may not balance bill you for covered services. Glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. Glossary of health coverage and medical terms page 2 of 6 deductible an amount you could owe during a coverage period usually one year for covered health care services before your plan begins to pay. Glossary of health insurance terms health insurance for. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. It is a way to distribute the financial risk associated with the variation of individuals health care expenditures by pooling costs over time prepayment and over people. Group code a unique three to five digit number assigned by the naic to identify those companies that are part of a larger group of insurance companies. Our comprehensive, easytouse glossary provides definitions for common health insurance terms to help you better understand your health care.
Health care services that help a person keep, learn or. Understanding your explanation of benefits pdf document. A person who is covered because of another persons health insurance, typically a child or spouse. Some health insurance or plans dont coun t all of your copayments, deductibles, coinsurance payments, out ofnetwork payments or other expenses. Jan 07, 2014 this document contains a list of commonly used health insurance terms and their definitions to help consumers better understand how health insurance coverage works. Habilitation services health care services that help a person keep, learn or. Souq al mal is arabic for money market is the leading comparison website in the middle east and lets you compare financial products before you say i do. Consumer glossary national association of insurance. 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.
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. A number of references were used in developing the definitions below. Providence health plan has three networks that are matched to our various plans. Those can be found in your insurance policy or certificate. A provider network is a collection of providers, hospitals and facilities that have agreed to set reimbursement rates for health care services delivered to members of a health insurance plan. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into.
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. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. 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. Medical insurance glossary of terms health medicare pdfs.
Glossary of health coverage and medical terms page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. Glossary december 12, 2008 health insurance terms this glossary defines terms that are commonly used to describe aspects of private health insurance. Glossary of health insurance terms by rmhp in comparing and evaluating health plan options, the industry terminology can be a little overwhelming. Glossary of health insurance terms blue cross and blue. Health insurance glossary understanding health care terms. Insurance terminology north american training group. When making decisions about health coverage, consumers should know the specific meanings of terms used to. Health insurance terms and definitions the money doctor. Unlike deductibles in other forms of insurance, the deductible is quoted annually, with all medical claims going towards the amount.
The insurance contracts act allows an insurer to avoid a policy ab initio in situations where an insured fraudulently non. Grievance a complaint that you communicate to your health insurer or plan. Glossary of insurance terms the az for insurance practitioners terms generally associated with reinsurance ab initio a term used to describe avoidance of a contract from its inception or its beginning. Health insurance terms and definitions valuepenguin. Direct loss a loss which is a direct consequence of a peril. Glossary of medical insurance terminology pdf uc merced. The amount can vary by the type of covered health care service. Often, health insurance companies use technical terms that may be unfamiliar to you. You can get a copy of the policy at or you may call 1800xxxxxxx.
Glossary of health insurance terms national health policy forum. Health insurers are required to make the glossary of health insurance terms medical expenditure panel meps. Glossary of health coverage and medical terms page 2 of 4 excluded services health care services that your health insurance or plan doesnt pay for or cover. Please refer to your policy or certificate of insurance for exact definitions of terms and coverage provisions. A federal and statefunded health insurance program for lowincome children, elderly, blind or disabled people.
Other terms and more information are in your insurance policy or certificate. A company owned solely or in large part by one or more non insurance entities for the primary purpose of providing insurance. Additional terms are available through the glossary page. An overall deductible applies to all or almost all covered items and services. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. The maximum amount of benefits a health insurance plan will pay over a persons lifetime. Health insurance glossary important terms and definitions. Coinsurance a form of medical cost sharing in a health insurance plan that. Glossary of health insurance terms san mateo county health. Bold text indicates a term defined in this glossary.
Agent the insurance company representative who sells policies on behalf of the insurer. This glossary of health insurance and healthcare terms defines commonly used terms, is intended for educational purposes and may differ from language used in your policy. This can make selecting the perfect health plan difficult. Health care services and supplies you get in your home under your doctors orders. Glossary of health coverage and medical terms just plain clear. Glossary of insurance terms actuary a professional trained in the mathematics of insurance and risk management, including the calculations of premiums, policy reserves and other values. The deductible is paid for each calendar year, and this out of pocket expense has to be paid before the insurance company pays the remaining costs.
Gatekeeper under some health insurance arrangements, a gatekeeper is responsible for the administration of the patients treatment. A deductible is a costsharing requirement under a health insurance policy that provides that the insurer will not be liable for a specified rupee amount in case of indemnity policies and for a specified number of dayshours in case of hospital cash policies which will apply before any benefits are payable by the insurer. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. These terms and definitions are available in additional languages via this page. Hipaa health insurance portability and accountability act of 1996 the federal law enacted in 1996 which eased the job lock problem by making it easier for individuals to move from job to job without the risk of being unable to obtain health insurance or having to wait for coverage due to. Health insurance glossary health insurance definitions and. The plan must also limit the total amount of out of pocket cost. 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. In the united states, this level is determined by the department of health and human services. Declaration part of the insurance policy that identifies the named insured, policy period and limit of insurance. An individual plan can cover you andor any of your eligible family members. The federal poverty level fpl is the set minimum amount of. Health insurance glossary and key terms health insurance policies can get confusing fast.
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