The period of time during which the insurance policy holder’s eligible medical expenses count toward their minimum deductible.
Also known as: deductible period, deductible accumulation period
Some insurance policies, especially life insurance policies, have age limits above which they won’t accept applications for or renew insurance policies.
Also known as: insurance age limit, age limit for insurance policies, age limit for insurance eligibility
Medical practices or forms of medical treatment defined as alternative medicine may include those not generally recognized by the medical community. Alternative medicine may include acupuncture, homeopathy, aromatherapy, naturopathy, and other Eastern or non-traditional medicines. Many insurance companies do not provide insurance coverage for alternative medical treatment.
Also known as: Eastern medicine, non-traditional medicine, homeopathy, homeopthic medicine, naturopathy, acupuncture, chiropractic care
Medical care diagnosis, certain forms of treatment, surgery and rehabilitation that are provided as outpatient services. These may or may not be covered at different rates than other types of medical care.
Also known as: outpatient care, ambulatory medical treatment
annual coverage limit
The dollar limits insurers will pay over the course of a year. Most of these plans are being phased out and may not be permitted as of January 1, 2014.
Also known as: annual health insurance coverage limits, annual coverage limits, annual limits
approved health care facility or program
A medical facility, hospital, program or clinic approved by a holder’s health insurance plan. These approved health care providers, facilities and programs are authorized to provide specific services for specific medical conditions covered by insurance.
Also known as: approved health care program, approved health care provider
Any medical service, treatment or supply (including prescription medications and equipment) covered by health insurance plans is known as a benefit.
Also known as: insurance benefit, benefit plan, insurance benefits
The maximum amount the health insurance company will pay for a specific benefit.
Also known as: maximum health care benefit, maximum insurance benefit
The package of medical and health-related services and supplies health insurance companies cover for holders of health insurance plans are benefit packages.
Also known as: insurance benefit packages, package of insurance coverages
cafeteria insurance plans
Cafeteria health insurance and benefit plans are those that allow employees to choose which benefits and insurance coverage they most want. Most insurance cafeteria plans available through employers show a list of prices and allow employees to choose whichever coverages they want as long as they fall under a certain total cost limit.
Also known as: cafeteria health insurance plans, a la carte insurance plans
Federal legislation that allows employees and/or employees’ dependents to continue to receive group health insurance coverage through the employer’s health insurance plan, at the individual’s expense after termination of employment.
Also known as: Consolidated Omnibus Budget Reconciliation Act of 1985, COBRA insurance coverage
certificate of coverage
A document given to insured individuals that describes the benefits, limitations and exclusions of coverage provided by the insurance company.
Also known as: certificate of insurance coverage
Specific charges insurance holders pay for medical services or supplies before insurance kicks in to cover the rest of the fees.
Also known as: co-pay, copays, copay
A specific dollar amount health insurance companies require insurance plan holders to pay before the health insurance plan begins to make payments. Not all health insurance plans require a deductible, but most do.
Also known as: insurance deductible, deductible amount
Health insurance coverage for spouses and unmarried children of insured individuals. Age and other restrictions may apply.
Also known as: dependent health insurance coverage, coverage for dependents
A list of prescription medications covered by health insurance plans.
Also known as: approved drug list, prescription formulary
flexible spending account
FSAs allow holders to set aside pre-tax money for common medical costs. These funds must be used by the end of the term-year. Allowed services may include copays for doctors’ visits, hospital fees, medical test costs, rehabilitation, physical therapy, dental care, orthodontic care, inpatient rehabilitation care for alcohol and drug addiction, vaccines and immunizations.
Also known as: FSA
HMO plans require insured members to use providers from a certain list of primary care doctors. The primary care doctor will refer out to other HMO specialists if additional treatment or specialty care is needed.
Also known as: Health Maintenance Organization
health reimbursement account
Health reimbursement accounts allow employers to set aside funds for health care costs accrued by their employees. These funds reimburse covered services paid for initially by employees.
Also known as: HRA, HRA accounts, reimbursement medical plans
health savings account
Health savings accounts allow holders to save for future medical costs. Money put in the account is not subject to federal income tax when deposited and can build up and be used in the future.
Also known as: HSA, high-deductible health savings accounts
A health survey that measures your current health, health risks and quality of life. Some insurance plans require holders to undergo a health assessment before coverage begins to establish a baseline for expected health care needs and costs.
Also known as: health assessment tests, insurance health assessments
Health insurance coverage set over a set amount of time is known as long-term insurance.
Also known as: term insurance
medically necessary health care
Services, supplies or prescription drugs needed to diagnose or treat medical conditions are known as medically-necessary health care.
Also known as: medical necessity, medically necessary care
A healthcare provider who is not part of an insurance plan’s authorized provider network. Costs for care provided by out-of-network providers may be higher than in-network providers, or may not covered by insurance providers.
Also known as: out of network provider, NNP, OONP, non-authorized provider
Insurance that covers certain services for a set short time period, usually six months or less.
Also known as: short term insurance coverage, short term medical insurance plans
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