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Insurance Principles

Adjustment Remaining portion after the insurance carrier has met its financial responsibility and patient responsibility has been determined; must be written off of the account
Allowed amount The maximum dollar amount the third party will reimburse a provider for a specific service
Benefits The health insurance coverage a member receives and the specific conditions under which the coverage is provided
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) Provides health care benefits to individuals with 100% service-related disabilities and their families
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) Medical benefits program for military members and their families; replaced by TRICARE
Claims register A log that lists information about each claim submission to an insurance carrier
Closed-panel HMO Providers are either HMO employees or belong to a group that has a contract with an HMO, requiring them to care for any and all members assigned to the provider by the HMO
Coinsurance Patient's financial responsibility once all covered expenses have been reimbursed by the health care plan
Commercial insurance carrier a company that supplies health insurance coverage to individuals and/or groups
Consolidated Omnibus Budget Reconciliation Act (COBRA) Federal act that gives former employees the right to continue their existing health care coverage under their employers' plan for a limited time at the former employees' expense
Covered expenses Health insurance reimbursement for medically-related expenses
Deductible Patient's annual financial responsibility that must be met before the health care plan begins paying for health care costs
Eligibility The conditions members must meet to be eligible for coverage under a policy
Created by: tina.reynolds