| Coinsurance:
The amount you are required to pay for medical care in a
fee-for-service plan
after you have met your deductible. The coinsurance rate is usually
expressed as
a percentage. For example, if the insurance company pays 80 percent of
the
claim, you pay 20 percent.
Coordination
of Benefits: A system to eliminate duplication of benefits
when you are
covered under more than one group plan. Benefits under the two plans
usually are
limited to no more than 100 percent of the claim.
Co-payment:
Another way of sharing medical costs. You pay a flat fee every time you
receive
a medical service (for example, $5 for every visit to the doctor). The
insurance
company pays the rest.
Covered
Expenses: Most insurance plans, whether they are
fee-for-service, HMOs, or
PPOs, do not pay for all services. Some may not pay for prescription
drugs.
Others may not pay for mental health care. Covered services are those
medical
procedures the insurer agrees to pay for. They are listed in the policy.
Deductible:
The amount of money you must pay each year to cover your medical care
expenses
before your insurance policy starts paying.
Exclusions:
Specific conditions or circumstances for which the policy will not
provide
benefits.
HMO
(Health Maintenance Organization): Prepaid health plans. You
pay a monthly
premium and the HMO covers your doctors' visits, hospital stays,
emergency care,
surgery, checkups, lab tests, x-rays, and therapy. You must use the
doctors and
hospitals designated by the HMO.
Managed
Care: Ways to manage costs, use, and quality of the health
care system. All
HMOs and PPOs, and many fee-for-service plans, have managed care.
Maximum
Out-of-Pocket: The most money you will be required pay a year
for
deductibles and coinsurance. It is a stated dollar amount set by the
insurance
company, in addition to regular premiums.
Non-cancellable
Policy:
A policy that guarantees you can receive insurance, as long as you pay
the
premium. It is also called a guaranteed renewable policy.
Compare & Save on Health Insurance!
PPO
(Preferred Provider Organization): A combination of
traditional
fee-for-service and an HMO. When you use the doctors and hospitals that
are part
of the PPO, you can have a larger part of your medical bills covered.
You can
use other doctors, but at a higher cost.
Pre-existing
Condition: A health problem that existed before the date your
insurance
became effective.
Premium:
The amount you or your employer pays in exchange for insurance coverage.
Primary
Care Physician: Usually your first contact for health care.
This is often a
family physician or internist, but some women use their gynaecologist.
A primary
care doctor monitors your health and diagnoses and treats minor health
problems,
and refers you to specialists if another level of care is needed.
Provider:
Any person (doctor, nurse, dentist) or institution (hospital or clinic)
that
provides medical care.
Third-Party
Payer: Any payer for health care services other than you.
This can be an
insurance company, an HMO, a PPO, or the Federal Government.
|
