Insurance Terms
This is the monthly amount a patient pays for coverage.
What is Premium?
This type of plan requires a primary care physician referral to see a specialist.
What is HMO?
A flat amount a patient pays for each doctor visit.
What is a Copay?
The statement sent to a patient showing what was covered and what they owe.
What is an EOB (Explanation of Benefits)?
A patient pays $30 for each visit.
What is a Copay?
The percentage of cost shared between patient and insurance after deductible.
What is Coinsurance?
This federal program covers people age 65+ or certain disabled individuals.
What is Medicare?
The amount a patient must pay before insurance begins paying.
What is a Deductible?
When the patient authorizes the insurance company to pay the provider directly.
What is Assignment of Benefits?
A patient must pay $1,000 before insurance covers costs.
What is a Deductible?
A request sent to the insurance company for payment after services.
What is a Claim?
This plan allows more flexibility with network providers, but often costs more.
What is PPO?
After the deductible, the insurance pays 80% and patient pays 20%.
What is Coinsurance?
Insurance approval required before certain procedures.
What is Prior Authorization?
A patient sees a specialist without a referral and must pay higher costs.
What is Out-of-Network?
Services not covered by an insurance policy are called this.
What are Exclusions?
State-funded health coverage for low-income individuals.
What is Medicaid?
The total amount a patient pays out-of-pocket is limited by this.
What is Out-of-Pocket Maximum?
When a patient has more than one insurance, this determines which pays first.
What is Coordination of Benefits?
Insurance covers 100% of a flu shot.
What is Preventive Care?
The person who owns the insurance policy
Who is the Policyholder?
This plan combines features of HMO and PPO, offering mixed coverage.
What is POS (Point of Service)?
Coverage for routine checkups or screenings that is fully paid by insurance.
What is Preventive Care?
An insurance request that is rejected because it’s not covered.
What is a Denied Claim?
A worker injured on the job is covered by this type of insurance.
What is Workers’ Compensation?