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Health Insurance
Mr. G’s Insurance Terms
| Question | Answer |
|---|---|
| Deductible | Amount of money a patient must pay for services BEFORE health insurance pays its share of the bill. |
| Co-Insurance | A specific percent of the expenses are shared by the patient and the insurance company; for example, in a 80 - 20 percent co insurance, the company pays 80% and the patient pays 20%. |
| Co-payment | An out of pocket fee aid by a person with health insurance at the time a covered service, such as an office visit or prescription, is received. |
| Premium | The monthly fee paid by the subscriber (patient) for insurance coverage; may be deducted from payroll check. |
| Preferred Provider Organization or PPO | A type of managed care: practitioners are grouped together to provide health care and agree to a set fee paid by the insurance company. |
| Health Maintenance Organization or HMO | Type of managed care provider that focuses on preventive care. |
| Point of Service Plans or POS | A hybrid of a HMO and PPO. Have smaller deductibles and co payments, but they require the patient to get a referral before seeing a specialist. |
| Medicare | Health insurance for those 65+ and disabled - funded through social security taxes |
| Medigap | A supplement health insurance plan used to covers health care cost not covered by Medicare. |
| Medicaid | State-funded insurance for blind, disabled, low income people |
| CHIP | Health insurance for children that do not qualify for Medicaid. |
| TRICARE | Health care plan provided for active duty personnel, family, retired military personnel, and survivors of military personnel |
| Worker's Compensation | Health insurance through the employer that pays for the healthcare of workers injured on the job |
| Managed care | The general term used by insurance companies to describe the attempt to provide quality health care at minimal cost. Used to limit healthcare costs. |
| HIPAA | Health Insurance Portability and Accountability Act - health care law that gave standard way to transfer patient files and protect CONFIDENTIALITY. |
| Protected health information or PHI | All individually identifiable personal information obtained through health care. Includes a patients name, medical record number, birth date, Social security number, address, telephone number, email, employer and so on. |
| Electronic Health Record or EHR | A medical record that contains information from all of the clinicians involved in a patients care which can be created and managed by authorized clinicians and staff across more than one health care organization. |
| Explanation of Benefits or EOB | A detailed account of each claim processed by the insurance company. which is sent to the patient as notification of claim or denial. |
Created by:
rotechams
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