Health Care Glossary
This is a list of terms you should be familiar with when deciding which insurance option is the best for you.
Services rendered by health care providers other than a physician, such as laboratory, radiology or other diagnostic imaging, physical therapy or other service.
The amount of payments for medical services that an insurance plan will make in a year. Any amounts incurred during the year above the annual maximum are the insured person’s responsibility.
A percentage of the cost of service that the insured person has to pay. For example, a plan may pay 80% of the charges and you pay 20%.
The amount that an insured person must pay for a covered service, in addition to the insurance payment. For example, most HMOs have a co-payment of $10-$25 for each doctor’s office visit and $250 for each hospitalization.
Medical expenses incurred by an insured person that meet the insurance company’s requirements for being eligible for benefit payments.
The amount that must be paid by the insured person for health care services before the insurance company will pay claims.
An emergency is a sudden, serious, and unexpected acute illness, injury or condition that you reasonably perceive could permanently endanger your health if medical treatment is not received immediately. Usually the insurance company has sole and final determination as to whether services were rendered in connection with an emergency.
The amount of total claim payments an insurance plan will make for one patient the entire time they are covered by the plan.
The rate you pay to be enrolled in the insurance plan.
A charge considered not to be excessive based on the circumstances of the care provided including:
- Level of skill or experience involved;
- The prevailing or common cost of similar services or supplies; and
- Any other factors that determine value
A sudden, serious, or unexpected illness, which requires immediate care for the relief of severe pain or diagnosis and treatment of such condition.