| 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.
Health
Insurance Quotes
Get Quotes for a variety of different health plans, including
individual and family, small group, short-term, student, Medicare
supplemental and dental plans.
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.
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