Health Insurance
With this plan you pay less if you use doctors, hospitals, and other health care providers that belong to the plan's network. With this plan you are required to get a referral from your primary care doctor in order to see a specialist
POS, Point of Service
A physician who directly provides or coordinates a range of health care services for a patient
Primary Care Physician
A fixed amount you pay for a covered health care service, usually when you receive the service
Co-Payment
Health care services a person receives at home
Home Health Care Services
Ambulance services for an emergency medical condition
Emergency Medical Transportation
This national health insurance program provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis
Medicare
A physician, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services
Primary Care Provider
When a provider bills you for the difference between the
provider's charge and the allowed amount
Balance Billing
Care in a hospital that usually doesn't require an overnight stay
Hospital Outpatient Care
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse
Emergency Services
This health insurance program is a federal and state program in the United States that helps with medical costs for some people with limited income and resources
Medicaid (Medi-cal in CA)
A physician who focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions
Specialist
The amount you owe before your health insurance begins to pay
Deductible
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so sever as to require emergency room care
Urgent Care
Health care services that your health insurance or plan doesn't pay for or cover
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)
EPO, Exclusive Provider Organization
A Provider who doesn't have a contract with your health insurer or plan to provide services to you
Non-preferred provider
The amount that must be paid for your health insurance or plan
Premium
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay
Hospitalization
Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled
Rehabilitation Services
In this health plan you pay less if you use providers in the plan's network. You are able to use doctors, hospitals, and providers outside of the network without a referral for an additional cost
PPO, Preferred Provider Organization
A physician, health care professional or health care facility licensed, certified or accredited as required by state law
Provider
The most you pay during a policy period before your health insurance or plan begins to pay 100% of the allowed amount
Out-of-pocket limit
Services from licensed nurses in your own home or in a nursing home
Skilled Nursing Care
Services to provide comfort and support for a person in the last stages of a terminal illness and their families
Hospice Services