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Related Flashcards
Cards In This Set
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Balancing bill
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The practice of billing patients for any balance left after deductibles, coinsurance, and insurance payments have been made.
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Policy holder
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The individual in whose name the policy is written. The insured.
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Deductible
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When patients also pay a predetermined amount of money up front each year toward their medical expenses.
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Coinsurance
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After the yearly deductible is met, the patient shares the bill with the insurance company, what is this called.
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Out-of-pocket maximum
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When medical expenses reach a certain amount the UCR fee for covered benefits is paid in full by the insurer.
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Preexisting conditions
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A physical or mental condition of an insured that existed before the issuance of a health insurance policy.
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Group contract
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A contract of insurance made with a company, a corporation, or other groups of common interest wherein all employees or individuals (and their eligible dependents) are insured under a single policy.
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Disability insurance
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Insurance that pays the policyholder a specific sum of money in place of his or her usual income if the policyholder cannot work because of illness or accident.
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Premium
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A monthly fee paid by the insured (or policyholder).
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Indemnity (fee-for-service)
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Traditional healthcare policy where patients can choose any healthcare provider or hospital they want and change physicians at any time.
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Exclusions
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Illnesses or injuries not coverd by the policy.
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COBRA (Consolidated Omnibus Budget Reconciliation Act)
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This act allows continual group health coverage that otherwise would be terminated when an individual leaves his or her place of employment.
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Birthday rule
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An informal procedure used in the health insurance industry to help determine which health plan is considered "primary" when individuals (usually children) are listed as dependents on more than one health plan.
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COB (coordination of benefits)
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When a patient and spouse (or parent) are covered under two separate employer group policies, the total benefits an insured can receive from both groups plans are limited to not more than 100% of the allowable expenses, preventing the policyholder(s) from making a profit on health insurance claims.
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Participating provider
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A provider who contracts with the third-party payer and agrees to abide by certain rules and regulations of that carrier.
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