Words that Start with C
a limit on the total amount that the insurance will pay for a service per year, per benefit, or per lifetime.
What is a cap
federal health insurance for people who are 65 and older (and some younger people with disabilities)
What is Medicare
The amount that an individual or family is responsible for paying before being eligible for health insurance coverage
What is a deductible
The price paid by the patient for the insurance policy on a monthly or yearly basis
Premium
A dollar amount that the insured is responsible for paying even when the service is covered by insurance.
What is copayment?
a federal health insurance program that provides health insurance for adults and children with limited income
what is Medicaid
An individual may need to meet certain criteria to enroll in a health insurance plan. This is called being what?
What is eligible
These standards were used in the past by many insurance plans to determine the amount that would be paid to the provider of services
Customary, prevailing, and reasonable
In contrast to copayment, the percentage of the charges that the insured is responsible for paying
What is coinsurance
What is a HMO
Ratio of benefit payments to premiums collected - proportion of premiums spent on health services (lower is better for insurance company)
What is a medical loss ratio
a traditional health care model in which health care providers and hospitals are reimbursed based on the number of services and procedures they provide
What is fee for service?
The provider receives a set amount of money for each patient, regardless of the services the patience receives.
What is capitation
type of health insurance plan that offers a network of providers who have agreed to provide services at negotiated rates (outside providers are higher rates)
What is a preferred provider network?
what is the cost of health care that is not covered by insurance
out of pocket expenses
also known as "Obamacare" this 2010 health care reform law sought to increase health insurance coverage and address health care costs through reforms
What is the Affordable Care Act?
A service for which health insurance will provide payment or coverage if the individual is eligible - in other words, any deductible is already paid
Covered service
Health care program that provides for three groups - service members, retirees, and their families
what is Tricare?
the ability to continue employer-based health insurance after leaving a job
what is portability
a platform where individuals and small businesses can compare and purchase health insurance plans
What is a health insurance exchange