Health Insurance Terminology

Flashcards summarizing key terms and definitions related to health insurance terminology.

Actuarial Value

The minimum projected percentage of medical costs likely to be covered by a medical expense policy.

Affordable Care Act (ACA)

An Act enacted to make health insurance more accessible and affordable, introducing mandates, subsidies, and insurance exchanges.

Basic Hospital Expense Insurance

Policies that cover hospital room and board, miscellaneous expenses, and pay for specified hospital costs up to a stated maximum benefit.

Basic Medical Expense Insurance

Health insurance policies providing 'first-dollar' benefits for specified and limited health care.

Basic Physician Expense Insurance

Policies that cover non-surgical services provided by a physician.

Basic Surgical Expense Insurance

Policies covering the cost of surgeons, including fees for anesthesiologists.

Benefit Period

The length of time benefits are paid following a loss or the policy period during which claims count against limits.

Bronze Plan

An ACA metal tier plan with an actuarial value projected to cover 60% of typical medical costs.

Cafeteria Plans

Employee benefit arrangements that allow selection from a menu of benefits, including accident and health insurance.

Calendar-Year Deductible

A cumulative or all-cause deductible that requires meeting only once during the benefit period.

Carryover Provision

Allows insureds to carry over claims from the final three months of the policy year to the next year's deductible.