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Helpful Glossary to
Insurance Terms
State Risk Pool Plans
Resources-- Links to
other health and insurance related web sites that are worth visiting.
The sites include government and not for profit resource directories as
well as insurance and related information sites. We recommend that you
mark this page as a "favorite" so that you can return when you
are looking for specific information. Hopefully these sites will be
able to help you.
MSAbank
-- Link to bank that will establish Medical Savings Accounts (MSA's)
and Health Savings Accounts (HSA's). Explains who can establish them
and how they work. Learn more about these excellent ways to control
your health care costs.
State
Insurance Department Web Site Listing Links to each states
individual Department of Insurance.
State of
Illinois Comprehensive Health Insurance
(CHIP)
Residents of Illinois who are unable to obtain health care coverage
through private health plans. Administrated by State of Illinois.
State of Indiana Comprehensive Health Insurance Association
(ICHIA)
Residents of Indiana who are unable to obtain health care
coverage through private health plans.
State of
Wisconsin Health Insurance Risk Plan (HIRSP) Residents
of Wisconsin who are unable to obtain health care coverage through
private health plans.
KidsCare for State of Illinois
Residents
Program to provide health insurance to children under 19 in families
that meet the program's income guidelines.
Pennsylvania's
Children's Health Insurance Program Pennsylvania's
nationally recognized program that provides free or low-cost health
insurance for children whose families earn too much to qualify for
Medical Assistance, but not enough to purchase private health insurance.
U.S. Government Site
for Medicare
Information about Medicare. Offical site for people with
Medicare.
U.S. Government Department
of Labor Site provides information about
health, and welfare issues in the workforce. Provides information about
COBRA, ERISA, employment law compliance and much more.
U.S. Government Center
Control and Prevention Is recognized as the leading federal
agency for protecting the health and safety of people - at home and
abroad, providing credible information to enhance health decisions.
Kaiser
Foundation The Henry J. Kaiser Family Foundation is an
independent philanthropy focusing on the major health care issues facing
the nation.
AMA Physician Directory Site maintained by American Medical
Association which provides a physican locator directory for individual
physicans and medical groups.
Insurance
Terms
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.
Copayment: 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. You must use the
doctors and hospitals designated by the HMO.
Managed Care:
Ways to manage costs, use, and quality of the health care system. All
HMOs and PPOs, and many fee-for-service plans, have managed care.
Maximum Out-of-Pocket:
The most money you will be required pay a year for deductibles and
coinsurance. It is a stated dollar amount set by the insurance company,
in addition to regular premiums.
Noncancellable Policy:
A policy that guarantees you can receive insurance, as long as you pay
the premium. It is also called a guaranteed renewable policy.
PPO (Preferred Provider
Organization): A combination of traditional fee-for-service and
an HMO. When you use the doctors and hospitals that are part of the PPO,
you can have a larger part of your medical bills covered. You can use
other doctors, but at a higher cost.
Preexisting Condition:
A health problem that existed before the date your insurance became
effective.
Premium: The amount
you or your employer pays in exchange for insurance coverage.
Primary Care Doctor:
Usually your first contact for health care. This is often a family
physician or internist, but some women use their gynecologist. A primary
care doctor monitors your health and diagnoses and treats minor health
problems, and refers you to specialists if another level of care is
needed.
Provider: Any
person (doctor, nurse, dentist) or institution (hospital or clinic) that
provides medical care.
Third-Party Payer: Any
payer for health care services other than you. This can be an insurance
company, an HMO, a PPO, or the federal government. |