12 terms

Health Care Vocabulary

Universal Health Insurance Co-Payment
This is a system in which all residents of a state, country or other geographic area have access to health care. The co-payment is the fixed-dollar amount which is due and payable by the member at the time a covered service is provided.
Medicare Cost Sharing
Medicare is federal health insurance program for individuals over age 65 and the disabled. There are no financial or income eligibility requirements. Cost-sharing is a method of dividing the cost of healthcare among consumers, insurance companies, employers and providers.
Medicaid Deductible
Medicaid is insurance program funded jointly by the federal and state governments for individuals and families with limited incomes or resources. Each state determines its eligibility requirements. A deductible is the amount an insured person must pay each year for medical expenses before the insurance policy begins to pay.
Managed Care Employer Sponsored Coverage
Managed care is a health care delivery system, comprising a spectrum of financial and structural relationships among purchasers, insurers, providers and members, designed to favorably affect the balance of access, cost, and quality of health care for a defined population of subscribers and members. This system is used in businesses for the employees.
Health Savings Account Preventative Care
Health savings accounts are personal savings account made available to those enrolled in a qualified high-deductible health plan. Funds are tax-free, tax deductible and may only be used for qualified health services. This is used for preventative care.
Health Maintenance Organization (HMO) Fee-for-Service Plan
HMO is a type of health care plan under which the enrollees receive all the medical services they need through a specific group of participating doctors and hospitals.
Preferred Provider Organization (PPO) Private Care
PPO is a health plan that contracts with various physicians and hospitals. Enrollees are offered a financial incentive to use providers on a preferred list, but many use non-network providers as well.
Cobra Mandated Employer Insurance
COBRA is The federal law applying to groups of 20 or more that offers extended coverage for enrollees and family members after group coverage would normally end. A federal act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event. Qualifying events are those that result in a loss of coverage, such as reduced work hours, death or divorce of a covered employee, and termination of employment.
Co-Insurance Primary Care Provider
Coinsurance is the percentage of the allowed amounts for covered services that BCBSNC will pay after you meet your deductible.
Premium Subsidized Health Insurance
Premium subsidized health insurance is health care in which the government pays for a portion of health services.
Uninsured Single-payer System
Uninsured single-player system is when the health care system in which one entity -- usually a government -- is the single payer for all health care services, using revenue from taxation.
Underinsured Third-party Payer
The uninsured third-party player is any organization, such as a private health insurer, Medicare or Medicaid, that pays for some of the health care expenses of its enrollees.