Accumulations
It is a regular payment, typically made on a monthly basis, to maintain the health insurance policy and access the benefits provided by the plan.
What is Premium?
A managed care plan that includes primary care physician (PCP) and referral requirements. It offers in-network coverage and will only reimburse out-of-network providers for emergency services.
What is Health Maintenance Organization (HMO)?
The inability to conceive after one year of regular, unprotected sexual intercourse.
What is Infertility?
An alphanumeric medical codes used to classify and code various health conditions and diseases.
What is ICD-10/Diagnosis Codes?
It is a one-year period benefit year that begins on January 1 and ends on December 31.
What is a Calendar Year?
The amount you pay for covered health care services before your insurance plan starts to pay.
What is Deductible?
A type of managed care plan that does not have primary care physician (PCP) or referral requirements. It includes in-network coverage and will only reimburse out-of-network providers for emergency services.
What is Exclusive Provider Organization (EPO)?
An infertility treatment in which a woman carries the baby for nine months and is genetically linked to the child.
What is Surrogate/Surrogacy?
A way to figure out who pays first when 2 or more health insurance plans are responsible for paying the same medical claim.
What is Coordination Of Benefits (COB)?
This is when your insurance policy sets a cycle cap or limit to the amount they would cover for procedures related to a specific benefit.
What is Cycle Restriction?
A fixed amount you pay for a covered health care service, usually when you receive the service.
What is Copay?
A type of managed care plan that does not require a primary care physician (PCP) or referrals. It provides coverage for both in-network and out-of-network services.
What is Preferred Provider Organization (PPO)?
An infertility treatment in which a woman carries the baby for nine months on behalf of the intended parents. In this arrangement, the woman serves solely as a carrier and has no genetic connection to the child.
What is Gestational Carrier?
These codes are used to identify products and supplies.
What is Healthcare Common Procedure Coding System (HCPCS)?
The other term for Dollar Restriction.
What is Lifetime Maximum Amount?
This is the percentage of costs of a covered health care service you pay after you've paid your deductible.
What is Coinsurance?
A type of managed care plan that may or may not include primary care physician (PCP) and referral requirements. It provides coverage for both in-network and out-of-network services.
What is Point-Of-Service (POS)?
A state regulation requiring insurance companies and employers to provide infertility benefits to their members.
What is Mandate to Cover?
The term used to describe the practice of insurance plans subcontracting or outsourcing a specific set of benefits to another plan or network.
What is a Carve-Out Plans?
It is the 12-month period during which your health plan is effective. It is determined by your employer’s group coverage start date or anniversary.
What is Plan/Policy/Service/Contract Year?
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
What is Out-Of-Pocket Maximum?
A type of plan that allows individuals to access healthcare services without requiring a primary care physician (PCP) referral, offering more flexibility in choosing healthcare providers.
What is Open-Access?
A state regulation that allows insurance companies and employers to choose whether or not to provide infertility benefits to their members.
What is Mandate to Offer?
This is a healthcare facility where surgical procedures are performed on an outpatient basis.
What is Ambulatory Surgical Center (ASC)?
This is the date on which the insurance benefits are currently active, allowing the individual to start receiving the plan's health services.
What is Current Eligibility Date?