Health Insurance Today

Created by mao_susan 

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15 terms

balance billing

patient may be responsible for paying the difference

birthday rule

is an informal procedure used in the health insurance industry to help determine which health plan is considered primary when individuals are listed as dependents on more than one health plan

CMS-1500 form

a universal form created by the government for Medicare claims and since adopted by most third-party carriers

coinsurance

patient shares the bill with the insurance company

Consolidated Omnibus Budget Reconciliation Act (COBRA)

health benefit provisions in 1986

coordination of benefits (COB)

came into being several years ago when it was common for a husband and wife to each have the same or similar group health insurance benefits but on different policies.

disability insurance

A form of health insurance that pays the policyholder a specific sum of money in place of his or her ususal income if the policyholder cannot work because of illness or accident.

exclusions

when insurance policy does not cover certain medical conditions (illness or injuries not covered by policy)

group contract

is a contract of insurance made with a company, a corporation, or other groups of common interest whrein all employees or individuals (and their eligible dependents) are insured under a single policy

indemnity (fee-for-service)

is the traditional kind of healthcare policy where patients can choose any healthcare provider or hospital they want

out-of-pocket maximum

when medical expenses reach a certain amount, the UCR fee for covered benefits is pain in full by the insurer

participating provider (PAR)

one who contracts with the third-party payer and agrees to abide by certain rules and regulations of that carrier

policyholder

A person who pays a premuim to an insuracne company and in whose name the policy is written in exchange for the insurance protection provided by a policy of insurance.

preexisting conditions

When certain illnesses or injuries exist before the effective date of an insurance policy and are not covered by the policy, these conditions are commonly referred to as:

premium

payment for insurance

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