An agreement where you make regular payments to a company and the company promises to pay you money if you suffer an injury, illness, loss, etc.
Policy
Nathan needs to pay coinsurance of 80/20 on a bill of $1,000. Assume he has already paid his deductible this year. How much is he paying?
$200
A formal request from the customer to an insurance company asking for a payment based on the terms of the insurance policy.
Claim
Scott goes to the Doctors office and gets lab tests done. His copay is $25 and his bill comes out to $75 after coinsurance. How much does he have to pay for that visit?
$100
A set dollar amount you agree to pay each time you receive medical treatment, while the insurance company agrees to cover the rest.
Copayment
The amount of money you agree to pay towards your losses before your insurance coverage will begin paying.
Deductible
Mrs. Weeks' insurance plan has a $500 deductible (none of which has been paid yet), after which the insurance company pays 90% of all charges. Mrs. Weeks has a medical procedure that costs $1500. How much of the bill will the insurance company be responsible for paying?
$600
the cost of the contract or policy. It refers to the amount people pay to have health insurance whether they use it or not.
Premium
Alice pays $150 a month for her insurance. Her only other medical expense for the year is a doctors visit for $25. How much is she paying in medical expenses at the end of the year?
$1,825
This insurance is best for people who are 65+
Medicare
a percentage of covered medical expenses that you pay after paying the deductible.
Coinsurance
The patient's coinsurance percentage is stated as 75/25 in the insurance policy. The deductible for the year has been met. If the visit charges are $1,000, what is the insurance company going to pay?
$750
the maximum amount of money you will have to spend on health care in a year, after which the insurance company agrees to cover all costs.
Max-out-of-pocket
The patient's coinsurance percentage is stated as 75/25 in the insurance policy. The deductible for the year has been met. If the visit charges are $1,000, What amount will the patient be billed?
$250
This insurance is free or low-cost health coverage for low-income people and families
Medicaid
a law that requires all Americans to have health insurance.
Affordable Care Act
You go to the hospital and incur $7,500 worth of medical expenses. Your deductible is $500, your coinsurance is 80/20 and your out of pocket max is $2,000. How much do you have to pay out of pocket?
$1,900
The four "tiers" of the Affordable Care Act are
Bronze, Silver, Gold, Platinum
How much does the insurance company pay if a patient has a $250 office bill, a $500 deductible (all of which has been met for this calendar year) and an 80/20 coinsurance plan?
$200
The resource/service where individuals can compare health insurance plans and get all questions answered
Marketplace
This health insurance plan has higher premiums and no need for a Primary Care Physician
PPO
Shawn pays $250 a month for health insurance. At the end of the year he has a total bill of $6,000. He visits the doctors twice ($25 each) and goes to the ER once ($50). His deductible is $500, his coinsurance is 70/30 and his out-of-pocket max is $1,000. How much does Shawn owe at the end of the year?
$4,600
This health insurance plan has lower premiums and limits the doctors you can go to
HMO
Melody has health insurance through her employer's plan. She has a $500 annual deductible and is then covered at a coinsurance of 80/20. Melody sees Dr. Timms for an office visit which totals $180.00. When the medical assistant calls to verify Melody's insurance benefits, she discovers that Melody has met $425 of the annual deductible. How much should the medical assistant collect from Melody for today's office visit?
$96
an illness or injury experienced before enrollment in a health insurance plan
Pre-existing conditions