Here is an alphabetical list of some words that may be helpful as you apply and choose a plan. It is estimated that outofpocket expenditure of over 1520 % of total health expenditure or 40. 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. Coinsurance a form of medical cost sharing in a health insurance plan that requires an insured person to pay a. Health insurance is full of terms you may not know. It serves as an introduction to health insurance from the point of view of consumers under the age of 65 who purchase a health insurance plan. A complaint that you communicate to your health insurer or plan. Glossary of health insurance terms coinsurance your share of the costs of a covered health care service, calculated as a percent for example, 20% of the allowed amount for the service. This document is for informational purposes only and is not intended to alter or replace the insurance policy. Glossary of commonly used healthcare terms 340b program. Health insurance is one of the ways that people in various countries finance their medical needs.
Insurance is an intricate product and so is its glossary. Please refer to your policy or certificate of insurance for exact definitions of terms and coverage provisions. March 08, 2018 understanding key health insurance terms. Understanding key health insurance terms healthcare. If you need further assistance, you can call the kentucky health benefit exchange at 8554596328, visit healthcare. To help you better understand health insurance, heres a list of the most commonly used health care terms and definitions. Some people can get health insurance through a group health plan offered by their employer or their spouses employer. Habilitation services health care services that help a person keep, learn or. An independent agent represents more than one company. Ppaca requires that everyone who can purchase health insurance for less than 8% of their household income do so or pay a tax penalty. Glossary of health coverage and medical terms omb control numbers 15452229, 12100147, and 09381146 page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list.
A health insurance plan that meets the minimum essential coverage requirements under the affordable care act. 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. 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. 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. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. When making decisions about health coverage, consumers should know the specific meanings of terms used to. Different health insurance policies can offer different benefits, and some can limit which doctors, hospitals, or other providers you can use. See your summary of benefits and coverage for information on how to get a copy of your policy or plan document. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. Health insurance is a contract between you and your health insurer to cover your medical expenses. A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.
Health insurance basics 101 guide to health insurance. Health insurance can feel like a language of its own. Agent the insurance company representative who sells policies on behalf of the insurer. Different types of insurance oklahoma state department. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Accountable care organizations acos actuarial equivalence. 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. Instead of, or in addition to, paying a fixed amount up front a copayment or deductible, the co insurance is a percentage of the total cost that insured person may also pay. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into. Glossary of health insurance terms university of st.
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. Glossary of life insurance terms department of financial. Insurance plans can differ in which providers you can see and how much you have to pay. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Some health insurance or plans dont coun t all of your copayments, deductibles, coinsurance payments, out ofnetwork payments or other expenses. Consumer glossary national association of insurance. Here we have listed and defined a few common terms used in health insurance. Onexchange plans are offered through blue cross and blue shield of illinois.
Department of health and human services hhs dependent coverage. Glossary of health insurance terms blue cross and blue. Although this glossary is not exhaustive, it reflects an attempt to unify the usage of words that are consistently used in a managed care setting. Items and services that are covered by your insurance plan.
An agent can be independent agent who represents at least two insurance companies or a direct writer who represents and sells policies for one company only. Glossary of commonly used healthcare acronyms and terms. 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. Care health plan hopes that this first edition of the englishspanish managed care glossary of termsis used to improve communication with spanish speakers. Glossary of common health insurance terms cf foundation. Glossary of health insurance terms national health policy forum. Glossary of medical insurance terminology pdf uc merced. Your health insurance company helps pay for some or all of your medical care, depending on the type of insurance plan you have. Its important to understand your costs and key health insurance terms, so youll know what services your plan will pay for. Acute care a pattern of health care in which a patient is treated for an acute immediate and severe episode of. The report therefore can be viewed as an introduction to the. A comprehensive law passed in 2010, aimed at reforming americas health care system. Glossary of health coverage and medical terms just plain clear.
Health maintenance organization hmo a health care financing and delivery system that provides comprehensive health care services for enrollees in a particular geographic area. To help you feel more confident choosing a health plan, this section breaks down some of the most common health insurance terms. Many large health insurers offer shortterm options. 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. 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. Life insurance resource center glossary of life insurance terms agent an insurance company representative licensed by the state who solicits and negotiates contracts of insurance, and provides service to the policyholder for the insurer. Shortterm health insurance may still be worth it to cover a short coverage gap of one or two months for example, if you looking for a new job or a new job has a waiting period before your health insurance kicks in.
Talk with your diabetes care team to find out what parts of your care are covered by your plan. This document contains a list of commonly used health insurance terms and their definitions to help consumers better understand how health insurance coverage works. Refer to your health plan policy or booklet for the provisions and terms of your. The definitions in this glossary are developed by the naic research and actuarial department staff based on various insurance references. Health insurance terms university of south florida.
Additional terms are available through the glossary page. These health insurance terminologies will give you a better understanding of health. An individual plan can cover you andor any of your eligible family members. Copay this is a predetermined flat fee that you pay for a specific health care. Learn about the different types of health insurance coverage that are available, and which may be the right health plan for you, from the experts at ehealth. Getting to know and understand the terms can go a long way to help you understand the plan and thus choosing the best one. Deductible the amount you pay for covered health care services before your health insurance begins to pay. Actuary a person in the insurance field who decides insurance policy rates and reserves dividends as well as conducts various other statistical studies. The different types of health insurance plans updated on february 12, 2020. You may have to pay a deductible each plan year before your insurance company starts to pay for your care.
He did not mean to hit the identify key terms associated with insurance and risks. Individual market the market for health insurance coverage offered to individuals other than in connection with a. Explain the purpose and importance of different types of insurance protection as a risk management strategy e. 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. Learn these terms so you can understand what you pay for health insurance. This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. The insurance contracts act allows an insurer to avoid. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. A health insurance policy like other policies is a contract between an insurer and an individual group in which the insurer agrees to provide specified health insurance cover at a particular premium subject to terms and conditions specified in the policy. Common health insurance terms and definitions wps health.
Facilities, providers, and suppliers that provide health care services at a set cost to people in a health insurance plan. Hmos require the use of specific, innetwork plan providers. The 340b drug pricing program enables eligible health care organizations known as covered entities to purchase drugs from manufacturers at reduced prices. Health care services that your health insurance or plan doesnt pay for or cover. Grievance a complaint that you communicate to your health insurer or plan. 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.
The amount you are required to pay for medical care in a feeforservice health plan after you have met. If you come across words that youre not sure about, check the list. Your share of the premium is deducted from your paycheck. Additionally, this informational sheet is not intended to fully set out your rights and obligations or the rights and obligations of the insurance company.
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