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Affordable Health Insurance Glossary

Benefit: The total amount of money payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss.

Case Management: a comprehensive system embraced by employers and insurance companies to ensure that individuals receive services when a claim is filed.

Claim: A request by an individual or their provider to the insurance company for the insurance company to pay for the medical services provided by a doctor, practitioner or hospital. Depending on the insurance company, a claim can be filed before or after the serviecs are provided.

Co-Insurance: A fee (usually small) that an individual is required to pay for services, after a deductible has been paid. This is also called "co-payment." Co-insurance can either be a flat fee or a percentage of the amount owed for the services.

Deductible: The amount owed by an individual for the health care expenses before the insurance will cover the costs. Deductibles often range from $500 - $2,500, depending on the health care plan.

Dependents: Just like with your taxes, dependents are individuals that depend on you for financial support. This typically, includes your spouse, biological children, and step children.

Exclusions: These are generally medical services that the will not be covered by an individual's insurance policy. Make sure that you fully understand what your exclusions are before you buy a policy.

Generic Drugs: A duplicate version of a brand name drug, that is sold for much cheaper and usually manufactured by the drug store or grocery store that you get your prescription filled at. Many times, generic drugs are just effective as brand name drugs.

HMO: An abbreviation for Health Maintenance Organizations, which represent "pre-paid" or "capitated" insurance plans in which a fixed monthly fee is paid for health care, instead of being charged for each visit to the doctor or hospital. With HMOs, the monthly fees don't increase upon getting medical services.

Insurance Agent: A licensed salesperson who represents one or more health insurance companies and sells insurance plans to consumers.

Network: A group of doctors, practioners, hospitals and health centers that are contracted to provide services to an insurance company's customers. Networks generally cover a large area, and the medical providers in that network usually charge cheaper fees.

Obamacare: A nickname for the Patient Protection and Affordable Care Act (PPACA), a U.S. Federal statute signed into law on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010, it represents President Barack Obama's health care reform legislation.

PPO: An abbreviatoin for Preferred Provider Organizations, which represents when an individual or their employer receives discounted rates if he/shee use doctors from a pre-selected group. If they use a physician outside the PPO plan, you must pay more for the medical care.

Underwriter: The insurance company that assumes responsibility for the risk, issues insurance policies and receives monthly premiums paid by the person being insured.

Waiting Period: A period of time, as indicated by the insurance company, when a person is not covered by health insurance for a particular problem. This usually happens when a policy is first activated.


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