Know your plans
This health plan usually requires members to choose a primary care physician and get referrals to see specialist providers
HMO
This is the amount you must pay out of pocket before your insurance starts to pay for the covered services
Deductible
A healthcare provider who does not have a contract with the insurance plan and typically results in higher out of pocket costs for the member
When a member has more than one insurance plan, this plan processes the claim before any others
Primary Insurance
People who are age 65 and older are usually eligible for this part of Medicare that covers hospital visits
Medicare Part A
This health plan allows members to see specialist without a referral and offers both in-network and out of network coverage
PPO
This is the amount you pay every month to keep your health insurance active
Premium
A healthcare provider who has a contract with the insurance plan and agrees to negotiated rates
Participating Provider or In Network Provider
The process that determines the order in which multiple insurances plans pay a claim to prevent over payment
Coordination of Benefits
This part of Medicare covers doctor visits and outpatient care for people age 65 and older
Medicare Part B
This Health plan combines features of both HMO and PPO plans, requiring a primary care provider but allowing out of network coverage
POS
This is the fixed dollar amount you pay for a doctor visit or prescription
Co-pay
This is the person legally responsible for paying the medical bill even if they are not the patient
Guarantor
This rule is used to determine primary coverage for the dependent when both parents have insurance that covers the child
Birthday Rule
This government health plan insurance program is based on income and household eligibility rather than age
Medicaid
Private Insurance
Who do patients call if they have questions about coverage and billing?
Their insurance provider, the number on the back of their card
This is the person who holds the insurance policy and whose name the plan is under
Subscriber
Medicare Supplemental Insurance
When an injury is caused by a car accident, this insurance may apply before health insurance
No-Fault Insurance
A plan that allows members to see virtually any doctor that they choose to receive coverage for services without authorization
Indemnity
This type of insurance helps pay the remaining cost after the primary insurance has paid
Secondary insurance
This is a person who is covered under the subscriber's insurance plan such as a spouse or child
Dependent
This insurance will never be primary except when Medicaid is present
Tri-Care
Workers' Compensation