Agreements vary from company to company, but most companies have agreements with hospitals to pay the hospital directly. As a general rule, you pay the doctor for the outpatient fee, and then you ask the health fund for reimbursement. You should be aware of this with your own company about their procedures. benefits provided by a physician or other health care provider under contract with the insurance company and paid at a higher level of benefits. Glossary health conditions health insurance is full of conditions that you may not know about. To help you better understand health insurance, here is a list of the most commonly used terms and definitions for health care. ABCDEFGHIJKLMNOPQRSTUVWXYZ A comprehensive law passed in 2010 to reform the U.S. health care system to improve access and affordability for more Americans. Eligible expenses The maximum amount a health plan reimburses a doctor or hospital for a defined benefit. Deductible each year The amount you must pay each year before the start of the reimbursement through your health care plan. The stand-alone requirement does not apply to prevention services.
Annual Cap An insurance plan may limit the dollar amount it pays for a year for a particular treatment or service or for all benefits in one year. B-Benefits Investigations or services covered by an insurance plan. Your insurance plan can sometimes be called a “benefit package.” C Disastrous plan The health insurance exchange will contain a disastrous plan option. Catastrophic plans have lower premiums, but do not begin to pay until they have paid a certain amount for covered services first, or simply cover more expensive levels of care, such as hospitalizations. Catastrophic plans are an option for young adults and youth, for whom coverage would otherwise be prohibitive. Application Form Application Form you or your doctor complete and submit your health benefit plan for payment. Right A broken bill for services provided to a member. COBRA This represents Consolidated Omnibus Budget Reconciliation Act of 1985. This federal law requires group health plans to allow workers and insured members to continue their group coverage for a period of time after a qualifying event that causes the loss of group health care. Qualifying events include reduced work schedules, termination of the employment relationship, aging child, Medicare authorization, death or divorce of an insured worker. Coinsurance Percentage of the cost of a covered health service or prescription drug that you pay after paying your deductible.
You pay 100 per cent of the total amount eligible until you pay your deductible. A hospital that has completed a specific health plan to provide hospital services to members of this plan. Copay (aka Copayment) The dollar amount you pay for a covered health service if you receive care or get a prescription drug. Cost Reduction (CSR) A discount that reduces the amount you have to pay for deductibles, co-insurances and supplements out of your pocket. You can get this discount if your income is below a certain level and you choose an insurance plan in the Silver Plan category. If you are a member of a state-recognized tribe, you may benefit from additional cost-sharing benefits. the entitled person included in the health care plan and all registered members of the rightful family.