Key Terms Used in Health Insurace

Published on Slideshow
Static slideshow
Download PDF version
Download PDF version
Embed video
Share video
Ask about this video

Scene 1 (0s)

[Audio] Association: A group. Often, associations can offer individual health insurance plans specially designed for their members. Basic Premium: A percentage of the standard premium that covers the initial administrative expenses the insurance company incurs while designing your policy. Benefit: Amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss. Carrier: The insurance company or HMO offering a health plan. Co-Insurance: Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company pays 80 percent. Co-Payment: Co-payment is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some HMOs require a $10 "co-payment" for each office visit, regardless of the type or level of services provided during the visit. Co-payments are not usually specified by percentages. Deductible: The amount of money you must pay for medical care expenses before your insurance policy starts reimbursing you. This amount must be met each year..

Scene 2 (1m 38s)

[Audio] Claim: A request for payment by a medical provider for a given medical service or item. Dependents: Spouse and/or unmarried children (whether natural, adopted or step) of an insured. Group Insurance: Coverage through an employer or other entity that covers all individuals in the group. ICD-9 (International Classification of Diseases 9th Edition): A standard format of identifying the illness, injury or diseases by using a three digit code. Also known as a diagnosis code Lifetime Maximum Benefit (or Maximum Lifetime Benefit): the maximum amount a health plan will pay in benefits to an insured individual during that individual's lifetime. Primary Care Physician (PCP): A health care professional who is responsible for monitoring an individual's overall health care needs. Typically, a PCP serves as a "quarterback" for an individual's medical care, referring the individual to more specialized physicians for specialist care. Providers - A generic term used to characterize those who provide health care services, instead of those who receive it, pay for it, or regulate it. Physicians, hospitals, pharmacies, and laboratories are examples of "providers.".