| Benefit:
The total amount of money payable by the insurance company
to a claimant, assignee, or beneficiary when the insured
suffers a loss.
Case
Management: a comprehensive system embraced by
employers and insurance companies to ensure that individuals
receive services when a claim is filed.
Claim:
A request by an individual or their provider to the insurance
company for the insurance company to pay for the medical
services provided by a doctor, practitioner or hospital.
Depending on the insurance company, a claim can be filed
before or after the serviecs are provided.
Co-Insurance:
A fee (usually small) that an individual is required
to pay for services, after a deductible has been paid. This
is also called "co-payment." Co-insurance can
either be a flat fee or a percentage of the amount owed
for the services.
Deductible:
The amount owed by an individual for the health care expenses
before the insurance will cover the costs. Deductibles often
range from $500 - $2,500, depending on the health care plan.
Dependents:
Just like with your taxes, dependents are individuals that
depend on you for financial support. This typically, includes
your spouse, biological children, and step children.
Exclusions:
These are generally medical services that the will not be
covered by an individual's insurance policy. Make sure that
you fully understand what your exclusions are before you
buy a policy.
Generic
Drugs: A duplicate version of a brand name drug,
that is sold for much cheaper and usually manufactured by
the drug store or grocery store that you get your prescription
filled at. Many times, generic drugs are just effective
as brand name drugs.
HMO:
An abbreviation for Health Maintenance Organizations,
which represent "pre-paid" or "capitated"
insurance plans in which a fixed monthly fee is paid for
health care, instead of being charged for each visit to
the doctor or hospital. With HMOs, the monthly fees don't
increase upon getting medical services.
Insurance
Agent: A licensed salesperson who represents one
or more health insurance companies and sells insurance plans
to consumers.
Network:
A group of doctors, practioners, hospitals and
health centers that are contracted to provide services to
an insurance company's customers. Networks generally cover
a large area, and the medical providers in that network
usually charge cheaper fees.
PPO:
An abbreviatoin for Preferred Provider Organizations, which
represents when an individual or their employer receives
discounted rates if he/shee use doctors from a pre-selected
group. If they use a physician outside the PPO plan, you
must pay more for the medical care.
Underwriter:
The insurance company that assumes responsibility
for the risk, issues insurance policies and receives monthly
premiums paid by the person being insured.
Waiting
Period: A period of time, as indicated by the insurance
company, when a person is not covered by health insurance
for a particular problem. This usually happens when a policy
is first activated.
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