Insurance Basics
What is the term for the amount you pay each month for your health insurance?
What is a premium?
This type of plan requires members to use a network of doctors and hospitals.
What is an HMO (Health Maintenance Organization)?
True or False: Preventive services like flu shots are usually covered at no cost.
What is True?
What is the document you receive that explains what your insurance paid and what you owe?
What is an Explanation of Benefits (EOB)?
What do you call the request sent to your insurance company for payment of services?
What is a claim?
What is the fixed amount you pay for a covered health care service, usually when you get the service?
What is a copayment/copay?
This type of plan allows more flexibility in choosing doctors and doesn't require referrals for specialists.
What is a PPO (Preferred Provider Organization)?
What type of care helps manage chronic conditions like diabetes or asthma?
What is preventive or chronic disease management care?
What term refers to a list of prescription drugs your plan covers?
What is a formulary?
This term describes the portion of the medical bill that the insurance company does not cover.
What is the patient responsibility?
What do we call the amount you must pay out-of-pocket before insurance starts covering expenses?
What is a deductible?
This type of plan combines high-deductible insurance with a tax-advantaged savings account.
What is an HSA-eligible plan?
Emergency room visits are usually covered under what part of your plan?
What is hospital services or emergency services?
What’s the term for the medical providers or hospitals that have agreed to discounted rates with your insurer?
What is an in-network provider?
If your insurance denies a claim, what can you file to have it reviewed?
What is an appeal?
What is the maximum amount you will pay for covered services in a plan year?
What is the out-of-pocket maximum?
What is the name of the plan that lets you see out-of-network providers but at a higher cost?
What is a POS (Point of Service) plan?
What type of health services include mental health or substance use disorder treatment?
What is behavioral health services?
If you go to a doctor not on your plan’s list, what are they called?
What is an out-of-network provider?
What term refers to the rate that insurance companies negotiate with providers for services?
What is the allowed amount or negotiated rate?
What is the percentage you pay for services after meeting your deductible?
What is coinsurance?
What does the acronym EPO stand for in health insurance?
What is an Exclusive Provider Organization?
Name one example of a service that might require prior authorization.
What is MRI, surgery, or specialist procedures?
What is the term for services that are not covered by your health insurance?
What are excluded services?
If you receive care and are billed before your insurance processes the claim, what should you wait for before paying?
What is the Explanation of Benefits (EOB)?