{"id":302,"date":"2021-04-09T20:12:41","date_gmt":"2021-04-09T20:12:41","guid":{"rendered":"https:\/\/haddixis.net\/?page_id=302"},"modified":"2021-04-09T20:18:08","modified_gmt":"2021-04-09T20:18:08","slug":"common-health-care-and-insurance-terms-defined","status":"publish","type":"page","link":"https:\/\/haddixis.net\/index.php\/common-health-care-and-insurance-terms-defined\/","title":{"rendered":"Common Health Care and Insurance Terms Defined"},"content":{"rendered":"\n
  1. Annual limit\/maximum<\/strong>
    A limit set by an insurer or employer-sponsored health benefits plan on the amount of covered treatment or services that will be considered covered during a single\u00a0plan year. Limits may be expressed in dollar or quantitative terms (e.g., no more than $1,000 annually or no more than 30 treatments annually).<\/li>
  2. Claim<\/strong>
    A request for payment for services covered under an insurance\u00a0benefit\u00a0plan. It requires a listing of services rendered, the service dates, and an itemization of costs. The completed\u00a0claim\u00a0form is sent to the patient\u2019s insurance carrier and serves as the basis for payment of benefits.<\/li>
  3. Co-insurance (coinsurance)<\/strong>
    The percentage of the bill you pay toward treatments and services.<\/li>
  4. Co-payment (copayment)<\/strong>
    This is a set amount you pay at each doctor\u2019s appointment.<\/li>
  5. Deductible\u00a0<\/strong>
    The amount you pay each year for services before your insurance plan begins covering costs.<\/li>
  6. Exclusions and limitations\u00a0<\/strong>
    These are services and procedures either not covered by the insurance plan or limited based on specific terms and conditions.<\/li>
  7. Explanation of benefits<\/strong>
    A written statement generated after a claim has been submitted showing what has been covered (or not covered) by the benefit plan. You may see this term shortened to just\u00a0EOB.<\/li>
  8. Fee-for-service<\/strong>
    It\u2019s a type of traditional indemnity plan. You can see any medical provider or specialist. Services are paid for separately. The plan pays a set amount of the cost for each covered medical expense.<\/li>
  9. Frequency<\/strong>
    The period of time that must pass before a patient is eligible again for a particular service. It\u2019s usually expressed in terms of months. For example, 2 exams every 12 months.<\/li>
  10. Generic drugs<\/strong>
    These are less expensive versions of brand-name drugs that are no longer covered by a patent. Generic drugs are made with the same amounts of active ingredients and almost always cost less.<\/li>
  11. Health maintenance organization (HMO)<\/strong>
    Under this plan, you pay a small co-payment for doctor and hospital visits. But, you must see providers participating in the HMO.<\/li>
  12. Health savings account (HSA)<\/strong>
    This tax-free savings account can be used to pay for qualifying medical expenses. An HSA requires enrollment in a high-deductible\u00a0health plan (HDHP). For 2021, the yearly maximum HSA amount for an individual plan is $3,600. For a family plan, it\u2019s $7,200. If you\u2019re age 55 and older, you can save an extra $1,000. Unused funds can be rolled over to the next year.<\/li>
  13. High-deductible health plan (HDHP)<\/strong>
    This plan features lower monthly premiums with higher deductible amounts. HDHP deductibles can be more than $2,000 for individuals and $5,000 for families.<\/li>
  14. In-network,\u00a0out-of-network<\/strong>
    Dentists, doctors, hospitals and other medical service providers are listed as \u201cin-network\u201d if they\u2019ve agreed to accept a set payment amount for covered services. It\u2019s generally less than the regular rate to save patients money. Providers not on the list are considered \u201cout-of-network,\u201d and you may pay more for their services.<\/li>
  15. Maximum Covered Expense<\/strong>
    The maximum amount a plan will pay or reimburse for a procedure. The patient pays the difference between the maximum covered expense and the procedure\u2019s actual cost.<\/li>
  16. Medicaid<\/strong>
    This is a federal and state-funded program for qualifying individuals who can\u2019t afford to pay for medical care.<\/li>
  17. Medicare<\/strong>
    A federal program for people age 65 and older, and those with certain disabilities, that helps pay for medical costs. People enrolled in the plan are responsible for set premiums, deductibles and co-payments. The\u00a0Medicare\u00a0benefit for prescription drugs is called Part D.<\/li>
  18. Medigap<\/strong>
    A private insurance plan that helps cover medical costs not paid by Medicare.<\/li>
  19. Out-of-pocket<\/strong>
    The expenses not covered under an insurance policy for which a member is responsible for paying. The acronym for this term may be shown as OOP.<\/li>
  20. Point-of-service (POS) plan<\/strong>
    Some HMOs allow coverage for specific out-of-network services. You may be able to visit specialists without a referral from your primary care physician.<\/li>
  21. Pre-existing condition<\/strong>
    An insurance company may not cover medical conditions you had before signing up for the plan.<\/li>
  22. Preferred Provider Organization (PPO)<\/strong>
    Also could be Participating Provider Organization. This term refers to a managed health care plan that arranges with health care providers to deliver health care at a discounted cost. It provides incentives for plan members to use providers who have contracted with the\u00a0PPO.<\/li>
  23. Premium<\/strong>
    This is a fee you pay to participate in a health care insurance plan. If you sign up for benefits through your employer, the cost (premium) is deducted from your paycheck.<\/li>
  24. Primary care physician<\/strong>
    You may see this this term written as PCP. It\u2019s the doctor you choose to provide routine care and who can refer you to a specialist.<\/li>
  25. Stop<\/strong>\u2013loss<\/strong>
    After meeting the plan deductible and reaching the maximum amount of co-payment required, the insurance company will cover 100% of the costs for the rest of the year.<\/li>
  26. Teledentistry<\/strong>
    Patients video chat directly with dental team members about their dental concerns. It requires a smartphone or computer with internet access. The office provides a secure link and directions for accessing the video chat.<\/li>
  27. Telemedicine<\/strong>
    A general term that covers all of the ways patients and their doctors can use technology to communicate without being in the same room. It includes phone calls, video chats, emails and text messages.<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    Annual limit\/maximumA limit set by an insurer or employer-sponsored health benefits plan on the amount of covered treatment or services that will be considered covered during a single\u00a0plan year. Limits may be expressed in dollar or quantitative terms (e.g., no more than $1,000 annually or no more than 30 treatments annually). ClaimA request for payment […]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":""},"yoast_head":"\nCommon Health Care and Insurance Terms Defined - Haddix Insurance Services<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/haddixis.net\/index.php\/common-health-care-and-insurance-terms-defined\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Common Health Care and Insurance Terms Defined - Haddix Insurance Services\" \/>\n<meta property=\"og:description\" content=\"Annual limit\/maximumA limit set by an insurer or employer-sponsored health benefits plan on the amount of covered treatment or services that will be considered covered during a single\u00a0plan year. 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