health insurance glossary
Health Insurance Net
Coinsurance:
The amount you are required to pay for medical care in a fee-for-service plan
after you have met your deductible. The coinsurance rate is usually expressed as
a percentage. For example, if the insurance company pays 80 percent of the
claim, you pay 20 percent.
Coordination
of Benefits: A system to eliminate duplication of benefits when you are
covered under more than one group plan. Benefits under the two plans usually are
limited to no more than 100 percent of the claim.
Co-payment:
Another way of sharing medical costs. You pay a flat fee every time you receive
a medical service (for example, $5 for every visit to the doctor). The insurance
company pays the rest.
Covered
Expenses: Most insurance plans, whether they are fee-for-service, HMOs, or
PPOs, do not pay for all services. Some may not pay for prescription drugs.
Others may not pay for mental health care. Covered services are those medical
procedures the insurer agrees to pay for. They are listed in the policy.
Deductible:
The amount of money you must pay each year to cover your medical care expenses
before your insurance policy starts paying.
Exclusions:
Specific conditions or circumstances for which the policy will not provide
benefits.
HMO
(Health Maintenance Organization): Prepaid health plans. You pay a monthly
premium and the HMO covers your doctors' visits, hospital stays, emergency care,
surgery, checkups, lab tests, x-rays, and therapy. read more »
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