Types of Insurance Plans
A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
Exclusive Provider Organization (EPO)
A specified amount of money that the insured must pay before an insurance company will pay a claim:
Diagnostic coding system implemented by the World Health Organization
Insurance that covers a defined group of people, for example the members of a society or professional association, or the employees of a particular employer.
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. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Health Maintenance Organization (HMO)
Is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
International Statistical Classification of Diseases and Related Health Problems
A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
Point of Service (POS)
A fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided.
The amount you pay for your health insurance every month.
A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
Preferred Provider Organization (PPO)
A type of health insurance plan that usually limits coverage to care from doctors
A process used by some health insurance companies in the United States to determine if they will cover a prescribed procedure, service, or medication.
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers.
Plans in the Health Insurance Marketplace are presented in 4 “metal” categories: Name those categories
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
A formal request submitted to an insurance company by a health care provider for medical services that are covered under the terms of the insurance policy.
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
Formulary