Coinsurance - Means you pay a certain
percentage (usually 20%) of the costs of services after a yearly deductible is met.
Copayment - The percentage of or preset fee
for the cost of an office visit or covered service
Covered Expenses - Medical expenses that are
paid for under the terms of a policy
Deductible - The amount of money you must
pay for medical expenses before the company pays anything
Exclusion - A service the health insurance
company will not cover or pay for
Health Maintenance Organization (HMO) - A type of managed care plan. With
an HMO, you pick a primary doctor who manages all of the medical services you receive.
HMOs cover the costs of many preventative services.
Indemnity Plan - A traditional type of health plan. With this type of
plan, also called fee-for-service, you can use any medical provider. You pay a yearly
deductible. After that, you pay a percentage of the cost of services until an
out-of-pocket maximum is met.
Managed Care - A health care system that finances and delivers care. The
goal is to provide health care that is cost effective and of high quality.
Point-Of-Service (POS) - An HMO that gives you the option to go to
providers outside of the plan's network of providers and still get some of the cost paid
for by the plan.
Pre-existing Condition - A health problem
you had when the insurance took effect
Preferred Provider Organization (PPO) - A managed
care plan in which a network of providers contracts with an organization to give medical
services at a discount to its members. With a PPO, you can choose one or more providers
from a list of those who participate with the health plan.
Prior Authorization - Approval ahead of time is needed from the health
plan for certain services to be covered
HEALTH AT HOME - Your Complete Guide to Symptoms, Solutions, and Self-Care © 1999 by Don R. Powell. American Institute for Preventive Medicine.
Date updated 04/20/99