Plan info
This date marks when your current health plan year resets.
What is start date or effective date?
A doctor who coordinates your care and gives referrals to specialists.
What is a PCP?
The set amount you pay before insurance starts paying for covered services.
What is a deductible?
A policy feature that defines coverage limits and exclusions.
What is the benefit structure?
The percentage you pay after your plan pays its share of covered services.
What is coinsurance?
This ID number is unique to each insured member and is used for all claims and billing.
What is the enrolment id?
This type of provider does not have a contract but can still treat members.
What is OON provider?
The total maximum amount a family will pay in a plan year for covered services.
What is family OOP Max?
This insurance helps cover hospital stays and major medical events.
What is a health insurance?
The amount you pay each month to keep your insurance active.
What is a premium?
This type of plan requires choosing a primary care physician (PCP).
What is HMO
Visiting this type of provider often results in higher costs and lower reimbursement.
What is a non participating provider?
The formal process of choosing plan features, coverage levels, and contribution structures.
What is plan design configuration?
When you have two insurance plans, this rule determines which pays first.
What is COB?
This refers to the shared financial responsibility between insurer and member for covered services.
What is cost share?
This plan type gives you the freedom to visit any doctor but costs less when using network providers.
What is PPO
A network’s group of doctors who focus on a specific medical field.
What is specialty network?
This plan combines features of an HMO and PPO.
What is POS?
The term used when two insurances share payment responsibilities.
What is a dual complete plan?
The total of all deductibles, copays, and coinsurance paid by a member in a year.
What is OOP spending?
The company paying a portion of your premium for health insurance.
Who is the employer or plan sponsor?
When a provider joins multiple networks for more patients.
What is multi network participation?
The point at which your plan starts paying 100% of covered expenses.
When OOP max is accumulated?
The government health plan for people with low income or disabilities.
What is medicaid plan?
The percentage paid after deductible for hospital stays.
What is inpatient coinsurance