Ppaca requires that everyone who can purchase health insurance for less than 8% of their household income do so or pay a tax penalty. He did not mean to hit the identify key terms associated with insurance and risks. Pdf knowledge of health insurance terminology and details. A health care system that assumes both the financial risks associated with providing comprehensive medical services insurance and service risk and the responsibility for health care delivery in a particular geographic area to hmo members, usually in return for a fixed, prepaid fee.
Different health insurance policies can offer different benefits, and some can limit which doctors, hospitals, or other providers you can use. A number of references were used in developing the definitions below. Glossary of health insurance terms national health policy forum. A company owned solely or in large part by one or more non insurance entities for the primary purpose of providing insurance.
Explain the purpose and importance of different types of insurance protection as a risk management strategy e. Agent an insurance company representative licensed by the state who solicits and negotiates contracts of insurance, and provides service to the policyholder for the insurer. Consumer glossary national association of insurance. Glossary of health coverage and medical terms just plain clear. There are various types of health insurance and different markets. Health insurance reimburses the costs of necessary medical treatment in the event. Health insurance terms ambetter from peach state health plan.
Instead of, or in addition to, paying a fixed amount up front a copayment or deductible, the co insurance is a percentage of the total cost that insured person may also pay. Health care services that your health insurance or plan doesnt pay for or cover. Insurance pdf types of insurance, scope of insurance. Department of health and human services hhs dependent coverage. Our insurance terms glossary is divided alphabetically by insurance terms in a quick reference guide to assist understanding the language commonly used by insurance companies. Health insurance is one of the ways that people in various countries finance their medical needs. Why is it important to know about health insurance. A complaint that you communicate to your health insurer or plan. In order to apply for such an insurance policy or to raise a claim for it, a certain type of form needs to be filled in and submitted to the insurance firm. Insurer the party who pays for losses in an insurance arrangement. Items and services that are covered by your insurance plan. Actuary a person in the insurance field who decides insurance policy rates and reserves dividends as well as conducts various other statistical studies.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. What a health insurance policy would normally cover. You may have to pay a deductible each plan year before your insurance company starts to pay for your care. Health insurance glossary health insurance definitions and. When making decisions about health coverage, consumers should know the specific meanings of terms used to. Annual deductible is the amount you must pay each year for medical and mental health expenses before your medical plan begins to pay benefits. Broad categories include life, health, motor, travel, home, rural, commercial and business insurance. Below are some of the basic health insurance terms and dont.
The insurer is required to renew the policy regardless of the health of the insured subject to policy conditions. Glossary of medical insurance terminology pdf uc merced. Acute care a pattern of health care in which a patient is treated for an acute immediate and severe episode of. This school of thought defines insurance in terms of. Definitions of health insurance terms in february 2002, the federal governments interdepartmental committee on employmentbased health insurance surveys approved the following set of definitions for use in federal surveys collecting employerbased health insurance data.
Introduction to insurance principles of insurance 18 the insured is the person or firm or company confronted by risk and the insurer is a person or firm or company, which specializes in the assumption of risk. Below are some of the basic health insurance terms and dont miss the handy dandy chart showing how theyre used. See your summary of benefits and coverage for information on how to get a copy of your policy or plan document. Annual limit many health insurance plans place dollar limits upon the claims the insurer will pay over the course of a plan year. The health insurance marketplace, or health insurance exchange, is a federal government website where you can shop, compare and buy plans offered by participating health insurance companies in your area. Insured the policyholder protected in case of a loss or claim. Insurance cover including the sums insured and rules on deductibles is definitively described in the terms and conditions of insurance. An agent can be independent agent who represents at least two insurance companies or a direct writer who represents and sells policies. If you dont see your plan listed, please call your insurance company, or call your healthnet health center. National health insurance in south africa policy paper. Insurance glossary understanding common insurance terms.
The insurance products taken out for you are shown in your insurance policy which you receive from your insurance broker. There are both private and public health insurance plans, with different plans offering different benefits. The definitions in this glossary are developed by the naic research and actuarial department staff based on various insurance references. Individual market the market for health insurance coverage offered to individuals other than in connection with a. Test your knowledge on important health insurance terms. It is estimated that outofpocket expenditure of over 1520 % of total health expenditure or 40. This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. In the united states, this level is determined by the department of health and human services. Glossary of health care terms health insurance illinois. Glossary of commonly used healthcare terms 340b program. The 340b drug pricing program enables eligible health care organizations known as covered entities to purchase drugs from manufacturers at reduced prices. To help you better understand health insurance, heres a list of the most commonly used health care terms and definitions. Glossary of life insurance terms department of financial. A transparent and competitive health insurance market where individuals, families, and small businesses can learn about their health coverage options, compare health insurance plans based on costs, benefits, and other important features, choose a plan, and enroll in coverage.
A financial risk management tool in which the insured transfers a risk of potential financial loss to the insurance company that mitigates it in exchange for monetary compensation known as the premium. Convertible term insurance policy an insurance policy that can be converted into permanent insurance without a medical assessment. Glossary december 12, 2008 health insurance terms this glossary defines terms that are commonly used to describe aspects of private health insurance. Different types of insurance oklahoma state department. Pennsylvania s health insurance market can be broken down into medicaid and chip, medicare, and commercial fullyinsured and selfinsured.
Jul 31, 2014 15 health insurance terms explained simply. Glossary of insurance terms actuary a professional trained in the mathematics of insurance and risk management, including the calculations of premiums, policy reserves and other values. Health insurance portability and accountability act of 1996 hipaa health maintenance organization hmo health reimbursement arrangement hra health savings account hsa highdeductible health plan hdhp indemnity health plan. Policy documents contain a number of insurance terms because they typically define the limitations of risk and liability on the insured and any exclusions of coverage. A benefit your employer, union or other group sponsor provides to you to pay for your health care services. Gatekeeper under some health insurance arrangements, a gatekeeper is responsible for the administration of the patients treatment. Et and the disparate impact of coronavirus on communities at 7 p.
Different types of insurance oklahoma state department of. Insurance policies, a contract between the policyholder and the insurance company, are of different types depending on the risk they mitigate. Agent the insurance company representative who sells policies on behalf of the insurer. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. South africa is in the process of introducing an innovative system of healthcare financing with far reaching consequences on the health of south africans. Life insurance contracts include qualified accelerated death benefit riders, other than riders that are longterm care insurance contracts under section 7702b, under section 818g. It is called 340b since that is the section of the public health service act that establishes the program. Glossary of healthcare terms health insurance and reform accountable care organization aco. Health insurance is full of terms you may not know. A comprehensive law passed in 2010, aimed at reforming americas health care system to improve access and affordability for more americans.
Policy terms and conditions religare health insurance. A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of patient care. Which agency regulate insurance sector in indiainsurance service pdf. Consumer driven health cdh this is a high deductible health insurance plan with lower premiums. The agreement is a contract also known as an insurance policy. The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. The federal poverty level fpl is the set minimum amount of. Health care services that help a person keep, learn or. Glossary of commonly used healthcare acronyms and terms.
Longterm care insurance longterm care insurance helps cover costs associated. Health insurance terms university of south florida. Choosing health insurance is one of the most important choices you can make to help protect the health and wellbeing of you and your family. Insurance pdf types of insurance, scope of insurance,classification definition. Pdf by 2014, uninsured adults will be eligible for health insurance through exchanges with multiple plan options.
That is why choosing a health insurance plan that is right for you, and understanding how it works, may seem confusing. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Commercial plans aetna elect choice epo anthem blue access anthem blue preferred anthem blue traditional bcbs. Insurance economic device whereby the individual or business pays a cost premium in exchange for protection against financial loss. A health insurance policy like other policies is a contract between an insurer and an individual group in which the insurer agrees to provide specified health insurance cover at a particular premium subject to terms and conditions specified in the policy.
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