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Frequently Used Health Insurance Terms
Copay: A fixed dollar amount, you pay
at the time services are rendered. Typical copays are for office
visits, prescriptions, or hospitalizations.
Coinsurance: A specified percentage of
the cost of treatment the insured is required to pay for all covered
medical expenses remaining after the deductible has been met.
Deductible: The portion of your health
care that you pay before insurance starts covering it. Typically,
the higher the deductible, the lower the premiums.
HMOs: Health Maintenance Organizations.
HMOs offer members an array of health benefits, usually including
preventive care -- for a set monthly premium.
Indemnity: Fee-for-service, allows you
to go to any hospital or doctor. You submit a claim and pay the
invoice (to be reimbursed later) or authorize the hospital or
doctor to collect their fees directly from your insurance company.
PPOs: Preferred Provider Organizations.
A PPO has arrangements with a network of doctors, hospitals and
other providers who have agreed to accept lower fees from the
insurer for their services.
Pre-existing condition: An illness, disease
or condition an individual has at the time of enrollment in a
health care plan. Pregnancy is not a pre-existing condition.
Premiums: The monthly or quarterly payments
paid for health insurance.
Catastrophic coverage: This plan pays
hospital and medical expenses above a certain (usually high) deductible.
The maximum lifetime limit may be high enough to cover the cost
of a catastrophic illness.
Long-term care policies: These cover medical
care, nursing care and certain in-home care if you ever become
unable to care for yourself due to an extended illness or disability.
Disability income insurance: This plan
will provide you with an income if you become unable to work due
to an injury or illness. Benefits are usually 60% of your income
at the time of disability.
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