Congressional research service 1 introduction congress has seen a renewed interest in questions related to the market for private health insurance since the passage of the patient protection and affordable care act aca. Glossary of healthcare terms health insurance and reform. Glossary of health coverage and medical terms page 1 of 4 glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. 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. Also called feeforservice plans, indemnity plans typically allow you to direct your own health care and visit whatever doctors or hospitals you like. Glossary of health insurance terms december 12, 2008 broker a salesperson who has obtained a state license to sell and service con tracts of multiple health plans or insurers, and who is considered to be an agent of. Health maintenance organizations hmos hmos emphasize prevention and offer a select choice of doctors and hospitals. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan.
Health insurance glossary health insurance definitions and. A device that has a chamber where instruments are placed and steam under pressure is injected, in order to complete sterilization. Glossary of medical insurance terminology pdf uc merced. Insurance holding company system consists of two or more affiliated persons, one or more of which is an insurer. 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. Amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss.
The type of health insurance in which we are usually interested is. When making decisions about health coverage, consumers should know the specific meanings of terms used to. Any activity done to help a person or group get something the person or group wants or needs. Benefit period when services are covered under your plan. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. This glossary explains what the words and phrases mean for health insurance. Health insurance and obamacare terms what does health reform mean to you. Glossary of dental insurance and dental care terms. Congressional research service 1 introduction congress has seen a renewed interest in questions related to the market for private health insurance since the passage of the patient protection and. Often, associations can offer individual health insurance plans specially designed for their members.
Accident for the purposes of health insurance, an accident is an unforeseen, unexpected and unintended event resulting in a bodily injury. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan. Glossary of health insurance terms skip secondary navigation ribbons. Ambulatory services health services provided to members who are not confined to a health care institution. Health insurance glossary carefirst bluecross blueshield. We want you to use it often, so you can become familiar with some of the words youll hear when you get medical. Medical insurance glossary of terms health medicare pdfs. Insured the persons covered by the insurance policy.
This health insurance glossary is not exhaustive and may not be accurate because usage of terms can vary. An individual designated by a policy holder to receive the benefits of an insurance policy. Health insurance glossary of terms admitting privileges. Different health insurance policies can offer different benefits, and some can limit which doctors, hospitals, or other providers you can use. This glossary defines commonly used health insurance and health care terms. This term may be used to describe ancillary products purchased in conjunction with a medical insurance plan. This limit must include deductibles, co insurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the health benefits. A provision in an insurance policy that states that the validity of the insurance contract cannot be contested after two or sometimes three years.
Glossary of health insurance terms blue cross and blue shield of. The charges agreed to by the preferred provider organization ppo for specified covered medical treatment, services and supplies. Allowed amount the highest amount we will cover pay for a service. Maximum amount paid per year for specific or total medical services. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written permission from the publisher. A guide to dental ppos, hmos and other managed plans, don mayes, revised edition, 2002. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. Health insurance is full of terms you may not know. Health insurance glossary health insurance definitions.
Some of these words are common with many types of insurance. Consumer glossary national association of insurance. Bold text indicates a term defined in this glossary. Those can be found in your insurance policy or certificate. Adjusted community rating means that the rates charged by insurance companies may vary by one or more variables such as age, gender, or health status. The health insurance or plan pays the rest of the allowed amount. 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.
Check out our health insurance glossary full of information and terms commonly used in the health industry. Health insurance 101 words to know when you need medical care 00. These glossary terms and definitions are intended to be educational and may be different from the terms. This is the share of the cost you pay for health care received after you meet your deductible. The most you pay during a policy period usually a calendar year before your health insurance or plan starts to pay 100% for covered health benefits. This glossary has many commonly used terms, but isnt a full list. Glossary of health coverage and medical terms just plain clear. A claim is a request by an individual or his or her provider to an individuals insurance company for the insurance company to pay for. The type of health insurance in which we are usually interested is comprehensive or major medical policies. It discloses what is covered, what is not, and dollar limits. Health insurance glossary understanding health care terms.
Gerber life insurance offers adult and childrens life insurance to help you protect your familys future. Here is some of the basic terminology for life insurance. Glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. The annual cycle in which a health insurance plan operates. Health maintenance organization hmo 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. Common terms used in health insurance small business health insurance plan resources in illinois.
The uniform glossary includes many commonly used health coverage and medical terms, but isnt a. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance. That would leave patients responsible for the balance due. Do you have a spouse or children who you want to provide for in life and in death.
This glossary is intended for educational purposes and may differ from the terms used in your insurance planpolicy. Annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. Health insurance glossary understanding healthcare terms. Health insurance glossary page access your availability to medical care which is determined by where you live and the type of health care facilities available in your area. Glossary of medical insurance terminology page 1 annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits.
Glossary of health insurance and medical terms page 1 of 4 glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. Health services provided to members who are not confirmed to a health care institution. Insurance regulatory information system iris a baseline solvency screening system for the national association of insurance commissioners naic and state insurance regulators established in the mid1970s. Health insurance glossary understanding health care. Some of these terms also might not have exactly the same meaning when. Providers who are not preferred providers of the insurance company may not even be. The term health insurance covers a wide range of policies that cover the costs of doctors and hospitals and those that meet specific needs, such as paying for longterm care. Find understandable and helpful definitions for common health insurance and healthcare terms in medical mutuals health insurance glossary. The money the insurance company pays the health care provider for medical services provided to you if you become ill or injured. A health insurance policy you buy directly from a health insurance company or broker rather than through an employer. Serving maryland, the district of columbia and portions of virginia, carefirst bluecross blueshield is the shared business name of carefirst of maryland, inc. Well give you an assist by helping you learn the language of health insurance.
An unforeseen and unintentional act identifiable in time and place. Anyone covered under your health plan that is not named as insured in your documentation from the insurance company. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Together, we created this glossary of key health insurance terms. View the carefirst health insurance glossary, containing helpful definitions that clarify terms or questions related to your health insurance plan. The insurance premium is what subscribers andor employers pay to the insurance company for the coverage. The uniform glossary includes many commonly used health coverage and medical terms, but isnt a full list. Word description ten day free look a notice on the first page of health insurance policies that the insured has ten days in which to examine the policy and return it for a refund of premium if he is not satisfied with the policy. Glossary of healthcare terms health insurance and reform accountable care organization aco. For example, if your health insurance plan covers 80% of the allowable charge for a specific service, you may be required to pay the remaining 20% as coinsurance. A description of the healthcare services and supplies that a health insurance company covers for members of a specific health insurance plan.
To help you better understand health insurance, heres a list of the most. Compare plans side by side, get health insurance quotes, apply online and find affordable health insurance today. An individual plan can cover you andor any of your eligible family members. The ability of a doctor to admit a patient to a particular hospital. When you assign benefits, you sign a document allowing your. Glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. Coinsurance a form of medical cost sharing in a health insurance plan that. View the expanded gerber life glossary of life insurance terms here. A licensed practitioner providing medical expertise and services within the scope of his or her license and practice. See if you qualify for a special enrollment period. The fee you pay for certain medical services or for each prescription.
Some health insurance companies may use some words with a diffferent meaning from those given in this health insurance glossary, and practices may vary among health insurance companies. You select a primary care doctor who coordinates all of your medical care including referrals to a specialist and hospital care, if necessary. Health insurance glossary of terms health coverage fast blog. A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of patient care. If this health insurance glossary doesnt help, please feel free to contact us with your questions a accident. You may have to pay a deductible each plan year before your insurance company starts to pay for your care. While every effort is made to ensure that this information is accurate and current, scai. The three most common managed health insurance plan choices are. You have another option, which is commonly called traditional, indemnity or feeforservice insurance, as well. But once you meet your outofpocket maximum, your insurance pays 100% of qualifying costs. When doctors or hospitals bill patients directly for care above what the insurer pays, it is known as balance billing. If your plan has a 20% coinsurance, your insurance may pay 80% of the cost and you might pay 20%.