Vocabulary
A specific amount of money that must be paid yearly before the benefits begin.
What is a Deductible
Laws that protect wage earners against the loss of wages and the cost of medical care resulting from occupational accidents and diseases.
What is Workers Compensation
Offered to all medicare recipients to cover the cost of their prescription drugs.
What is Medicare Part D
Health department, county hospital and senior citizen centers are example of this.
What is Local Health Services
A document sent by an insurer to a patient explaining what was covered for a medical service.
What is Explanation of Benefits?
Conditions like acquired immunodeficiency syndrome, attempted suicide, cancer, losses due to injury on the job, and pregnancy are reasons why a person should not be allowed to deduct expenses
What is a Policy Limitation
Providers or health care facilities that are part of a plan's network with which it has negotiated a discount.
What is In Network
Inpatient health care services, services in hospitals, nursing facilities, home health care, and hospice care.
What is Medicare Part A
U.S. Public Health Department, Veterans Administration Hospitals and Center for Disease Control are examples of this.
What is Federal Health Services
The amount that the insured person must pay out of pocket for services at a doctor's office.
What is a Co-Pay
The cost of the coverage that the insurance policy contains may vary greatly depending on the subscriber.
What is a Premium
Enrollees receive the highest level of benefits when they obtain services from a physician, hospital, or other health provider designated by their program as a preferred provider.
What is a Preferred Provider Organization
Some varieties of this plan may require members to pay a premium similar to the Medicare Part B premium.
What is Medicare Part C
A participant must reapply for Medicaid how often?
What is Yearly
The intentional deception or misrepresentation that results in unauthorized benefits to an individual or organization.
What is Insurance Fraud
The amount of time that an individual must wait to become eligible for coverage or a specific benefit.
What is a Waiting Period
A managed care organization developed to control the expenditure of health care dollars and to manage patient care.
What is a Health Maintenance Organization
Covers outpatient health care services, services by physicians and durable medical equipment.
What is Medicare Part B
Texas School of the Blind, CHIP's, State Mental Hospital and Department of State Health Services are examples of this.
What is State Health Services
When a claim is either paid or denied
What is Claims Adjudication
The approval of or concurrence with the treatment plan proposed by a medical professional before the provision of services will be covered by insurance
What is Preauthorization
These groups sign up health care providers who agree to charge a fixed fee for services.
What is a Managed Care Program
The national public health agency of the United States
What is Center for Disease Control & Prevention
Medicaid and other government health care services are funded through these.
What is Taxes
The amount the policy holder or his/her employer pays to the health plan each month to purchase health coverage.
What is a Premium?