Some health insurance or plans dont coun t all of your copayments, deductibles, coinsurance payments, out ofnetwork payments or other expenses. Health insurance portability and accountability act of 1996 hipaa health maintenance organization hmo health reimbursement arrangement hra health savings account hsa highdeductible health plan hdhp indemnity health plan. Explain the purpose and importance of different types of insurance protection as a risk management strategy e. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more. The results released based on these data collections are often called statistics. Open enrollment is a period of time set by the federal government every year during which you can shop for and buy health insurance if you dont already have it. Knowing the insandouts of an insurance plan will go a long way in helping to make the most of out of ones health coverage.
A company owned solely or in large part by one or more non insurance entities. Summary of the hipaa privacy rule hipaa compliance assistance ocr privacy brief. Your health insurance or plan may have preferred providers who are also participating providers. Understanding your explanation of benefits pdf document. Health insurance terms university of south florida. When group health insurance is an employee benefit, your employer usually pays a portion or all of the premiums.
Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. Evidencebased policymaking can improve the cost and quality of care for the aging. Broad categories include life, health, motor, travel, home, rural, commercial and business insurance. Health insurance is full of terms you may not know. 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 policy. Civil union partners student health benefit program. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance.
Glossary of health insurance terms blue cross and blue shield of. Which agency regulate insurance sector in indiainsurance service pdf. Pdf health insurance is one of the ways that people in various countries finance their medical needs. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. Below are definitions for some of the more commonly used terms and how. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Annual limit many health insurance plans place dollar limits upon the claims the insurer will pay over the course of a plan year. Other medical insurance terms copay this is a predetermined flat fee that you pay for a specific health care service. Agent the insurance company representative who sells policies on behalf of the insurer.
Glossary of health coverage and medical terms just plain clear. A request for payment for services or treatment rendered under the terms of an insurance policy. The national health insurance act, act 852 of 2012 provides for two types of private health insurance schemes private mutual and private commercial health insurance schemes. The health insurance portability and accountability act of 1996 hipaa is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patients consent or knowledge. Specialist the provider you see for special issues you may have outside of your basic health needs heart, liver, kidneys, bones, skin and others. A complaint that you communicate to your health insurer or plan. Evidence has shown that the reading difficulty of health insurance plan documents.
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. Data are facts on people, places and business collected in censuses and surveys and through administrative records e. 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. 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. Obtaining services from doctors within the health insurance plans network, called preferred providers, results in lower fees to participants. Medicare part b medical insurance helps cover doctor and other health care providers services, outpatient care, home health care, durable. Medicare part a hospital insurance helps cover inpatient care, skilled nursing facility care, hospice care, home health care. This means your costs for health insurance premiums will be lower than they. If you dont have minimum essential coverage, you may have to pay a penalty when you file your federal income tax return unless you qualify for a health coverage.
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. Members can take a free confidential hearing test by phone. Some health insurance or plans dont coun t all of your copayments, deductibles, co insurance payments, out ofnetwork payments or other expenses. In the united states, this level is determined by the department of health and human services. Network a group of doctors, hospitals and pharmacies that sign agreements with your insurance company to give you the best health care services possible.
Family good health insurance important notes about this insurance please read and check the details of this policy carefully to ensure its accuracy and see that it meets your requirements. The federal poverty level fpl is the set minimum amount of. There are both private and public health insurance plans, with different plans offering different benefits. Pdf knowledge of health insurance terminology and details. Health insurance reimburses the costs of necessary medical treatment in the event. Insurance cover including the sums insured and rules on deductibles is definitively described in the terms and conditions of insurance. The insurance products taken out for you are shown in your insurance policy which you receive from your insurance broker. To help you better understand health insurance, heres a list of the most commonly used health care terms and definitions.
Glossary of medical insurance terminology pdf uc merced. From meeting the deductible to knowing what services fall under preventive care, understanding what a plan covers and what it doesnt will make sure there are no curve balls when medical bills arrive by mail. Health insurance glossary health insurance definitions and. Health care services that help a person keep, learn or. Annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. Once you enroll in a health insurance plan, you usually cannot change to another plan until the next open season, usually set once a year. Department of health and human services hhs dependent coverage. A comprehensive law passed in 2010, aimed at reforming americas health care system to improve access and affordability for more americans.
Hipaa health insurance portability and accountability act of 1996. Health insurance terminology university of delaware. Insurance pdf types of insurance, scope of insurance. This glossary has many commonly used terms, but isnt a full list. Health insurance portability and accountability act of 1996. Legislation mandating specific privacy rules and practices for medical care providers and health insurance companies, designed to streamline the healthcare and insurance industries and to protect the privacy and identity of. Glossary of health coverage and medical terms page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. List of insurance terms and definitions for uniform translation term definition actuarial value the percentage of total average costs for covered benefits that a plan will cover. The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. 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. Why is it important to know about health insurance. Glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. The insurance cover provided under this policy to the insured person up to the sum insured and is and shall be subject to a the terms and conditions of this policy and b the receipt of premium, and c the information disclosed to us including by way of the proposal form by.
Please inform us immediately of any change in your address, occupation, state of health, or of any other changes affecting any insured person. Health insurance terms quiz how health insurance works. Health coverage that will meet the individual responsibility requirement of the affordable care act. See your summary of benefits and coverage for information on how to get a copy of your policy or plan document. Understanding insurance terms university of north florida. Association health plans this term is sometimes used loosely to refer to any health plan sponsored by an association. Medicare and health insurance terminology balance bill. Glossary december 12, 2008 health insurance terms this glossary defines terms that are commonly used to describe aspects of private health insurance. It also has a precise definition under the health insurance portability and accountability act of 1996 that exempts from certain requirements insurers that sell insurance to small employers only through. The insurance handbook reflects this diversity of subjects and issues. This study is the first to systematically map health policy recommendations for. A number of references were used in developing the definitions below. 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.
Insurance policies, a contract between the policyholder and the insurance company, are of different types depending on the risk they mitigate. Health care services that your health insurance or plan doesnt pay for or cover. Health maintenance organization hmo a medical group plan that provides physician, hospital, and clinical services to participating members in exchange for a. He did not mean to hit the identify key terms associated with insurance and risks. The only difference in legal terms is that private insurance is established by a. Legislation mandating specific privacy rules and practices for medical care providers and health insurance companies, designed to streamline the healthcare and insurance industries and to protect the privacy and identity of healthcare consumers.
Health insurance a generic term applying to all types of insurance indemnifying or reimbursing for losses caused by bodily injury or illness including related medical expenses. Glossary of health insurance terms national health policy forum. The health insurance or plan pays the rest of the allowed amount. Coinsurance a form of medical cost sharing in a health insurance plan that requires an insured person to pay a. That is why choosing a health insurance plan that is right for you, and understanding how it works, may seem confusing. Common health insurance terms id01900215 page 1 of 2 health insurance has its own set of commonly used terms. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. 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. A copay is in addition to the amount your insurance pays for the service. Insurance terminology north american training group, inc. Medicare part b medical insurance helps cover doctor and other health care providers services, outpatient care, home health care, durable medical equipment wheelchairs, walkers, hospital beds. Medical insurance glossary of terms health medicare pdfs.
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