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Health Insurance

Mr. G’s Insurance Terms

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