Health Insurance Terminology

When it comes to Health Insurance, there are numerous terms and vocabulary that are used to define insurance plans, procedures and other related data. It's important to become familiar with these terms, as they dictate the scope of one's coverage and plan. The U.S. Bureau of Labor Statistics (known as BLS) is the primary agency that classifies such terminology.

Significance

• The Federal Government's Interdepartmental Committee on Employment-based Health Insurance Surveys established a series of definitions that are utilized within the various collection proceedings. It's a good idea to become acquainted with the following key terms as they are regularly used and vital to know.

Types

• When it comes to healthcare insurance, there is a range of types available; the distinctions between indemnity plans versus managed care plans are important. An indemnity plan is the kind of medical plan where the patient and/or provider gets reimbursed for the expenses they acquire. The amount of reimbursement varies according to the policy, its requirements, restrictions, bans and riders. A good health insurance plan will cover a majority of all costs; leaving the individual with minimal out of pocket expenses (the amount of money they're directly responsible to pay).

Features

• Acronyms are often used when describing managed care plans, including HMO, PPO, POS and EPO. HMO stands for health maintenance organization; it's where a system takes on the financial responsibility and risk of the insurance individual(s), making them accountable for the facilitation of health care in a predetermined area. Individuals with an HMO generally pay a fixed fee for their coverage. PPO stands for preferred provider organization; a plan in which the coverage is granted to participants via a specific network of elected health care providers. If a person on this plan receives treatment from a provider or facility that's outside of the network, they'll have to pay for the rendered services at a much higher cost. A point of service plan is known as a POS; it's similar to an HMO in terms of the network services and provider reimbursement.EPO is an exclusive provider organization plan which, tends to be significantly more restrictive when it comes to the issue of providers; there is no partial coverage or reimbursement that will be received if one goes outside of the particular network.

Function

• Healthcare insurance can exist for a group of people or for a single individual. Through group health insurance, a sole policy covers the medical expenses of a number of people, as opposed to only one. An example of this is an employee, who receives their insurance from their employer or the company they work for. Every member is responsible for the same fee which is generally, deducted from their salary. The group's premium is determined by factors such as their profession and average age. Individual health insurance only involves the medical expenses of a specific person or family. The cost of this insurance is determined very differently; the person(s) cost reflects how much of a potential risk they may pose. Individuals are required to answer a number of questions pertaining to their health and may be required to get an examination.

Identification

• Additional relevant terminology includes co-payment; which is the fee that the insured is responsible for whenever they go for a medical service. The amount of the fee generally ranges from five to twenty dollars and the insurance company or provider is responsible for the remainder of the overall cost. The term covered expense, refers to the medical dealings that the insurer consents to pay for. Exactly what is covered (prescriptions, procedures) varies by the plan and health insurance policy. A deductable is the fixed amount of money in which the person(s) is responsible to pay for their medical expenses; before the insurer (health insurance policy) starts to make pay. Coinsurance refers to the total sum that one is obliged to pay for their medical care once they've met the deductable; inside a fee for service plan.
  Having knowledge health insurance terminology will prove to be helpful when it comes to things like choosing a plan or understanding the plan that you are currently enrolled in. Additional terminology and tutorials can be accessed by visiting the links provided to you below.