Glossary Of Health Insurance Terms
When it comes to health insurance, the language can get technical and confusing. In order to help you understand the terms relating to health insurance, here are some of them, along with their meanings.
Annual maximum benefit amount - This figure is predetermined according to your needs and premiums, and is the maximum that the insurer will pay toward your medical expenses.
Broker, insurance - an agent who does not represent only one company, but is licensed to sell insurance from many companies and can most likely give you a better deal on insurance.
Children's Health Insurance Program (CHIP) - this program is designed to provide medical assistance through Medicaid programs to children who are uninsured and are in a low income category
Claim - an itemized statement that lists medical expenses and is submitted to the insurer as proof of a need.
COBRA (Consolidated Omnibus Budget Reconciliation Act) - A government Act that declares that people who lose their group coverage through job loss, reduction of loss, or other situation, are guaranteed to be able to continue that coverage up to 18 months.
Coinsurance - the amount that you pay as a percentage of your healthcare costs that is left after the deductible and after the insurer has paid their percentage - often stated as 80 / 20.
Copay - an amount that you pay each time you visit the doctor or buy prescription medicine - usually ranging between $5 and $45, and is often referred to as out-of-pocket expenses.
Deductible - an amount you must pay per person before the insurance company will make any payment.
Exclusions – refers to medical problems which will not be covered, usually for a limited time, because of pre-existing conditions.
Fee For Service - a health insurance program that allows you to go to the physician of your choice, but which is also the most expensive.
Group Insurance – Insurance provided by an employer for a group of employees at a discount price. The employer often will pay a percentage of the premium, but is not required to do so.
HIPAA (Health Insurance Portability and Accountability Act) - this Federal Act guarantees continual coverage when getting new insurance.
HMO - provides health care through a network of doctors and hospitals.
Medicare - a Federally funded health insurance primarily for the elderly.
POS - provides health insurance coverage through a network of health care providers, but gives greater flexibility.
PPO - provides health insurance through a network of health care providers, but also allows the insured to receive care outside of the network.
Pre-existing Conditions - this term usually refers to medical problems that existed prior (less than six months) to a new health insurance plan became effective, they usually are not covered for a limited time.
Premium - the amount you pay each month for coverage. It may also be paid quarterly, semi-annually, or yearly.
Primary care physician – the doctor that oversees the medical care an insured plan member receives. He must refer the patient to other doctors before the insurer will pay for it.
Underwriting - the process whereby an insurer determines the cost of an individual’s insurance by considering the particular medical problems that either exist now or had existed.
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Free Health Insurance Quotes
By comparing health plans with other rates, you should be able to find the right plan. You can get your free health insurance quotes at the following sites:
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