Vocabulary
The health care items or services covered under a health insurance plan.
Benefits
Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Medicaid
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Preventive Services
What is a Primary Care Physician?
What is your family doctor, one you go to when sick, on a regular basis?
Age until when young adults can stay on their parent’s health insurance plans
26
The amount one pays monthly to maintain their health insurance.
Premium
A federal health insurance program for people 65 and older and certain younger people with disabilities.
Medicare
The time frame during which I can purchase health insurance
During the open enrollment periods
A physician, nurse practitioner, or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.
PCP or Primary Care Provider
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
Coinsurance
A specified amount of medical expenses that the member must pay before the insurance begins to pay.
Deductible
A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.
PPO or Preferred Provider Organization
A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.
Qualifying Life Event (QLE)
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
A Specialist
The most you have to pay for covered services in a plan year.
Out-of-pocket maximum
The contract or agreement that outlines the terms of insurance coverage.
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.
HMO or Health Maintenance Organization
A year of benefits coverage under an individual health insurance plan.
Benefit Year
A provider who doesn’t have a contract with your health insurer or plan to provide services to you.
A Non- Preferred or Out of Network Provider
What is it called when one provides false or misleading information to health insurance companies in an attempt to procure unauthorized benefits?
Health Insurance Fraud
A fixed amount a person pays for physician or specialist office visits.
Copayemnt
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
EPO or Exclusive Provider Organization
Health care services that your health insurance or plan doesn’t pay for or cover.
Excluded Services
A provider who has a contract with your health insurer or plan to provide services to you at a discount.
Preferred or In-Network Provider
A way to determine which plan pays first when 2 or What is yourself, Your Employer, the government, the market place?more health insurance plans are responsible for paying the same medical claim.
Coordination of Benefits