Health Insurance Vocab

Premium

The amount of monthly payment to receive the insurance benefit

Deductible

amount that must be paid by the patient for medical services before the policy begins to pay

Out-of-pocket maximum

A predetermined amount after which the insurance company will pay 100% of the cost of medical services.

Co-pay

a specific amount of money a patient pays for a particular service

EX) $20 for each service

Co-insurance

requires that specific percentages of expenses are shared by the patient and insurance company

EX) in an 80-20 percent plan- the company pays 80% and the patient pays the remaining 20%

In-Network

A list of service providers including pharmacies that agree to charge less for medical services

out-of-network

Medical providers that charge more for services that are not within your preferred group

Affordable Care Act (ACA)

A federal law that requires all Americans to have health insurance or pay a penalty

Health Savings Account (HAS)

An individual savings account that may be combined with high-deductible health plans to help pay for qualified medical expenses

Flexible Spending Account (FSA)

a monetary account, offered through an employer, into which money is put through payroll deductions, before it is taxed. Funds can be withdrawn for qualified medical expenses as needed, but the funds must be spent each year

Open Enrollment Period

A time frame where the consumer can change their health plan, usually arranged by the employer

Health Maintenance Organization (HMO)

an organization that provides comprehensive medical care to subscribers for a fixed fee - monthly fees or premiums are paid and people have to go to HMO providers

-most affordable healthcare option

Preferred Provider Organization (PPO)

This is a "managed-care" plan where the primary physician and others are in a "network" of providers that get a discount rate for services

Medicare

the federal health insurance program for people who are 65 or older, any person with a disability who has received Social Security benefits for at least 2 years, and people with End-Stage Renal Disease

Medigap Policy

Health insurance plan that helps pay medical expenses not covered by Medicare

Worker's compensation

health insurance plan providing treatment for workers injured on the job - administered by the state and payments are made by employers and the state

TRICARE

U.S. government health insurance plan for all military personnel

Value based compensation

Bundled payments; health payment plan in which doctors are paid for their performance.

Fee-for service compensation

a health payment plan in which doctors or providers are paid for each service they render

HIPAA

The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed.