Actuary a person in the insurance field who decides insurance policy rates and reserves dividends as well as conducts various other statistical studies. He did not mean to hit the identify key terms associated with insurance and risks. Learn these terms so you can understand what you pay for health insurance. Glossary of health coverage and medical terms just plain clear. Its important to understand your costs and key health insurance terms, so youll know what services your plan will pay for. Here is an alphabetical list of some words that may be helpful as you apply and choose a plan.
Explain the purpose and importance of different types of insurance protection as a risk management strategy e. The 340b drug pricing program enables eligible health care organizations known as covered entities to purchase drugs from manufacturers at reduced prices. 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. Glossary of health insurance terms national health policy forum. Different health insurance policies can offer different benefits, and some can limit which doctors, hospitals, or other providers you can use. Copay this is a predetermined flat fee that you pay for a specific health care.
Additional terms are available through the glossary page. Common health insurance terminology 101 many of the terms you encounter when dealing with health insurance are not familiar. Glossary of medical insurance terminology pdf uc merced. Consumer glossary national association of insurance. 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. 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. Care health plan hopes that this first edition of the englishspanish managed care glossary of termsis used to improve communication with spanish speakers. Your health insurance company helps pay for some or all of your medical care, depending on the type of insurance plan you have. 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. A complaint that you communicate to your health insurer or plan. Common health insurance terms and definitions wps health. Coinsurance a form of medical cost sharing in a health insurance plan that requires an insured person to pay a. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare.
Health care services that your health insurance or plan doesnt pay for or cover. Additionally, this informational sheet is not intended to fully set out your rights and obligations or the rights and obligations of the insurance company. March 08, 2018 understanding key health insurance terms. To help you better understand health insurance, heres a list of the most commonly used health care terms and definitions. 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. Insurance plans can differ in which providers you can see and how much you have to pay. Items and services that are covered by your insurance plan. Grievance a complaint that you communicate to your health insurer or plan. 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. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. Glossary of commonly used healthcare terms 340b program. This document is for informational purposes only and is not intended to alter or replace the insurance policy.
Talk with your diabetes care team to find out what parts of your care are covered by your plan. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. 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. 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. 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. Agent the insurance company representative who sells policies on behalf of the insurer. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. 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. A health insurance plan that meets the minimum essential coverage requirements under the affordable care act. Glossary of common health insurance terms cf foundation.
The insurance contracts act allows an insurer to avoid. Facilities, providers, and suppliers that provide health care services at a set cost to people in a health insurance plan. 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. Glossary of health insurance terms university of st. Understanding key health insurance terms healthcare. The definitions in this glossary are developed by the naic research and actuarial department staff based on various insurance references. Different types of insurance oklahoma state department.
An individual plan can cover you andor any of your eligible family members. Health maintenance organization hmo a health care financing and delivery system that provides comprehensive health care services for enrollees in a particular geographic area. Here we have listed and defined a few common terms used in health insurance. Health insurance is a contract between you and your health insurer to cover your medical expenses. Some health insurance or plans dont coun t all of your copayments, deductibles, coinsurance payments, out ofnetwork payments or other expenses. The report therefore can be viewed as an introduction to the. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into.
A comprehensive law passed in 2010, aimed at reforming americas health care system. Your share of the premium is deducted from your paycheck. 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. Hmos require the use of specific, innetwork plan providers. If you need further assistance, you can call the kentucky health benefit exchange at 8554596328, visit healthcare. 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. An independent agent represents more than one company. 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. Habilitation services health care services that help a person keep, learn or. Getting to know and understand the terms can go a long way to help you understand the plan and thus choosing the best one. It is estimated that outofpocket expenditure of over 1520 % of total health expenditure or 40. Accountable care organizations acos actuarial equivalence.
Refer to your health plan policy or booklet for the provisions and terms of your. The amount you are required to pay for medical care in a feeforservice health plan after you have met. Some people can get health insurance through a group health plan offered by their employer or their spouses employer. Glossary of life insurance terms department of financial. 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.
Department of health and human services hhs dependent coverage. Onexchange plans are offered through blue cross and blue shield of illinois. Health insurance is one of the ways that people in various countries finance their medical needs. Please refer to your policy or certificate of insurance for exact definitions of terms and coverage provisions.
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. 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. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. 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. This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. Health insurance terms university of south florida. 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. Deductible the amount you pay for covered health care services before your health insurance begins to pay. The different types of health insurance plans updated on february 12, 2020. 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 commonly used healthcare acronyms and terms. You may have to pay a deductible each plan year before your insurance company starts to pay for your care. This document contains a list of commonly used health insurance terms and their definitions to help consumers better understand how health insurance coverage works.
Health care services that help a person keep, learn or. Many large health insurers offer shortterm options. Health insurance is full of terms you may not know. To help you feel more confident choosing a health plan, this section breaks down some of the most common health insurance terms. 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. Insurance is an intricate product and so is its glossary. When making decisions about health coverage, consumers should know the specific meanings of terms used to. See your summary of benefits and coverage for information on how to get a copy of your policy or plan document. 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. Glossary of health insurance terms blue cross and blue.
The annual deductible is based on the calendar year, jan. Health insurance basics 101 guide to health insurance. Health insurance can feel like a language of its own. Individual market the market for health insurance coverage offered to individuals other than in connection with a. These health insurance terminologies will give you a better understanding of health. Acute care a pattern of health care in which a patient is treated for an acute immediate and severe episode of.
1161 958 1574 431 889 218 838 842 1407 489 842 1439 1338 1044 424 1162 173 7 740 756 690 1357 1427 789 563 806 1303 645 1281 284 110 557 1315