|
When
shopping for an insurance policy, you will come across
many terms specific to the insurance industry. Becoming
familiar with these terms will help you evaluate your
choices.
|
| Benefit
|
Something
positive your employer provides that is not required by
law, such as paid vacation, sick time, personal days and
child care. |
| Co-payment |
The
set amount that you pay each time you use a particular
service. For example, if your insurance plan has a co-payment
of $5 for each doctor visit, you will pay the doctor $5
at each visit and the insurance company pays the rest.
|
| Deductible |
The
amount of money you must pay in a fee-for-service plan
before the insurance payments begin. |
| Exclusions |
Services
not covered by the insurance plan. |
| Fee-for-service
plan |
A
"traditional" insurance plan, where the insurance company
pays a certain fee for each service performed, after the
patient pays a deductible. In a fee-for-service plan,
the patient can usually go to any doctor, not just a doctor
on a list. |
| Health
Maintenance Organization (HMO) |
A
company that offers health plans that provide medical
care from an approved network of providers, at a set fee
per visit. You must see a provider within the network,
or the HMO may not pay for the service. |
| In-plan
Provider |
Doctors
who have a contract with your insurance company to provide
services. Usually, you will be given a booklet listing
the doctors in your health plan. |
| Managed
Care |
A
concept that addresses how health care is contracted,
provided and paid for. HMOs are examples of managed care
in action. |
| Out-of-plan
provider |
Doctors
who do not have a contract with your insurance company.
If you are in an HMO, your plan may pay for services you
obtain from the out-of-plan provider. |
| Out-of-pocket |
Payments
you must make if you visit an out-of-plan provider or
if you obtain a service not covered by your policy. |
| Payroll
deduction |
Money
taken out of your paycheck before it is given to you |
| Point-of-service
(POS) |
Under
this plan, you choose a primary-care physician. If you
need a specialist, you may choose a doctor not working
directly with your PCP. You may be required to pay for
this specialist out-of-pocket, depending on your policy. |
| Policy |
A
special type of managed care plan under which you don't
usually need permission from your Primary Care Physician
to see a specialist. |
| Preferred
Provider Organization (PPO) |
A
special type of managed care plan under which you don't
usually need permission from your Primary Care Physician
to see a specialist. |
| Premium |
The
monthly payment paid to the insurance company for your
coverage. |
| Primary
Care Physician (PCP) |
The
doctor you choose as your main health care provider. Under
most HMOs, your PCP must give you permission to see a
specialist. |
| Provider |
The
doctor, nurse, dentist, pharmacist or other health care
professional that serves you. |
Add to del.icio.us
