Ppos and pos plans combine features from both feeforservice and hmos. Mcqa glossary of terms texas department of insurance texas. Our comprehensive, easytouse glossary provides definitions for common health insurance terms to help you better understand your health care. If your plan has a 20% coinsurance, your insurance may pay 80% of the cost and you might pay 20%. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Insurance holding company system consists of two or more affiliated persons, one or more of which is an insurer. Health insurance glossary health insurance definitions. That is why choosing a health insurance plan that is right for you, and understanding how it works, may seem confusing. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance. Glossary of health insurance and medical terms page 1 of 4 glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. Health insurance glossary terms hawaii department of. Selecting a top rehab isnt a decision to be arrived at. You can download a printer friendly pdf copy of the mcqa glossary here.
Health care terminology glossary aaahcc american accreditation health care commission aahcc accreditation is an important quality seal of approval for provider networks and managed. Learn the meanings of common health insurance terms like premium, deductible, coinsurance, copay, and guaranteed issue. It permits financial services companies to merge and engage in a variety of. But once you meet your outofpocket maximum, your insurance. When making decisions about health coverage, consumers should know the specific meanings of terms used to. They will also learn key health insurance terminology e. Health insurance a generic term applying to all types of insurance indemnifying or reimbursing for losses caused by bodily injury or illness including related medical expenses. Legal entitlement to payment or reimbursement for your health care costs, generally under the contract with a health insurance company. The maximum dollar amount that your health insurance company will pay a health care provider for a benefit i.
Insurance is an intricate product and so is its glossary. However, section 12 of aca gives states the flexibility to require the merger of the individual and small group health insurance. An insurance plan thats certified by the health insurance marketplace, provides essential health benefits, follows established limits on costsharing like deductibles, copayments, and outofpocket maximum amounts, and meets other requirements under the affordable care act. Glossary of insurance terms the az for insurance practitioners terms generally associated with reinsurance ab initio a term used to describe avoidance of a contract from its inception or its beginning. Health insurance glossary insurance compare insurance. The web browser you are using will no longer be supported by. Glossary of health coverage and medical terms page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. Additional health insurance products such as vision or dental insurance that may be added to a medical insurance plan for an additional fee.
A glossary of terms for community health care and services for older persons. Proposalform filled in by a person wanting to take out insurance. Why is it important to know about health insurance. Individual market the market for health insurance coverage offered to individuals other than in connection with a. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan. There are both private and public health insurance plans, with different plans offering different benefits. Insurance regulatory information system iris a baseline solvency screening system for the national association of insurance commissioners naic and state insurance regulators established in the mid1970s. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. Health maintenance organization hmo a health care system that assumes both the financial risks associated with providing comprehensive medical services insurance and service risk and the responsibility for health care. A government program that provides health coverage to some citizens who are younger than 65 years of age who cant afford private health insurance.
A company owned solely or in large part by one or more non insurance entities for the primary purpose of providing insurance. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Efforts to improve access often focus on providingimproving health coverage. At the end of this guide, there is a glossary of health insurance terms. Life and health insurance license exam manual, 2nd edition 2010 kaplan, inc. A contract that requires your health insurer to pay some or all of your health. A health insurance plan with higher monthly premiums and little to no deductible. Agent the insurance company representative who sells policies on behalf of the insurer. This is the share of the cost you pay for health care received after you meet your deductible. Health care services that your health insurance or plan doesnt pay for or cover. A complaint that you communicate to your health insurer or plan. Access plans wc network and health an action plan filed with the texas.
Insurance terminology north american training group. Insurance glossary india a to z terms of insurance. Ppaca requires that everyone who can purchase health insurance for less than 8% of their household income do so or pay a tax penalty. The percent for example, 40% you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance. In most studies on hospital merger effects, the unit of observation is the. Medicare a government program which provides health. Actuary a professional trained in the mathematics of insurance and risk management, including the calculations of. Health maintenance organization hmo a health care system that assumes both the financial risks associated with providing comprehensive medical services insurance and service risk and the responsibility for health care delivery in a particular geographic area to hmo members, usually in return for a fixed, prepaid fee. This glossary is available to give you general information about words and terms. Getting to know and understand the terms can go a long way to help you understand the plan and thus choosing the best one. Two large operators of blue cross and blue shield health insurance plans announced what they are calling a strategic affiliation that will merge key management and operational functions. Braided funding, the process of combining funds from different sources to. Medical insurance glossary of terms health medicare pdfs. See if you qualify for a special enrollment period.
Aggregate cost payments method of reimbursement of a health plan with a. The uniform glossary of health coverage and medical terms was developed as part of the health care reform affordable care act by the department of health and human services, department of labor, and the internal revenue service to meet the requirements of the summary of benefits and coverage document provision this glossary. The groups joining to form a cooperative must be similar in the. Care health plan hopes that this first edition of the englishspanish managed care glossary. An independent agent represents more than one company.
This page provides a glossary of insurance terms and definitions that are commonly. The text of this publication, or any part thereof, may not be reproduced in any manner whatsoever without written. Here we have listed and defined a few common terms used in health insurance. Glossary of insurance terms actuary a professional trained in the mathematics of insurance and risk management, including the calculations of premiums, policy reserves and other values. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance. Basic insurance terminology and definitions about life, health, automobile and home insurance to help you understand basic concepts and buy the right insurance. It likewise requires the same for the small group insurance market. Glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. The account may be funded by an individual, an employer or both.
Consumer glossary national association of insurance. Glossary of health insurance terms december 12, 2008. A person must be covered by a qualified high deductible health plan hdhp to contribute to an hsa. As you experience changing events in life and take on greater responsibilities, you may need to manage different kinds of life, health, automobile or home insurance. Some of these terms also might not have exactly the same meaning when. A health insurance contract may also be called a policy or plan. Big blue cross plans to create national health insurer. The member or spouse can get some life insurance benefits as an early payment.
A contract that requires your health insurer to pay some or all of your health care. The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. Compare plans side by side, get health insurance quotes, apply online and find affordable health insurance. Inaccuracies or omissions accidental or deliberate in a proposal may invalidate any insurance. Glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. Health insurance glossary understanding health care. These health insurance terminologies will give you a better understanding of health. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. Glossary of health coverage and medical terms page 1 of 4 glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. Federal health plan merger enforcement is consistent.
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