Health insurance portability and accountability act of 1996 hipaa the administrative simplification provisions of the health insurance portability and accountability act of 1996 hipaa, title ii required the department of health and human services hhs to establish national standards for electronic health care transactions and national. For a 20 percent health insurance coinsurance clause, the policyholder pays for the deductible plus 20 percent of his covered losses. Words associated with surety and bonds and title insurance are listed separately at the end of this list. Carrier another term for an insurer or insurance company. The guide is an important resource that will help to create a much greater understanding of. Insurance terminology north american training group. With the recent changes to health care laws and insurance procedures, there are many terms and phrases that may be unfamiliar. A comprehensive law passed in 2010, aimed at reforming americas health care system. Health insurance and obamacare terms what does health reform mean to you.
You can get a copy of the policy at or you may call. Glossary of health coverage and medical terms page 1 of 4 this glossary has many commonly used terms, but isnt a full list. The discontinuance of an insurance policy before its normal expiration date, either by the insured or the company. Glossary of health coverage and medical terms university. Glossary of health insurance terms cchp health plan. Some of these terms also might not have exactly the same meaning. These glossary terms and definitions are intended to be educational and may be different from the terms. An independent agent represents more than one company.
Health insurance glossary health insurance definitions and. Health insurance glossary texas department of insurance. To help you better understand health insurance, heres a list of the most commonly used health care terms and definitions. 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. Some health insurance or plans dont coun t all of your copayments, deductibles, coinsurance payments, out ofnetwork payments or other expenses. Coinsurance a form of medical cost sharing in a health insurance plan that requires an insured person to pay a. The following glossary is intended to be educational and may be different from the terms and definitions in your own insurance plan.
These glossary terms and definitions are intended to be educational and may be different from the. Pdf knowledge of health insurance terminology and details. Health insurance is full of terms you may not know. World health organization, regional office for europe, 1998. If your plan has a 20% coinsurance, your insurance may pay 80% of the cost and you might pay 20%.
The following is glossary of health benefit terms that are often used during open enrollment benefits season. Bold text indicates a term defined in this glossary. Glossary of health coverage and medical terms university benefits glossary of health coverage and medical terms glossary of health coverage and medical terms skip to main content. Some of these terms also might not have exactly the same meaning when. Medical insurance glossary of terms health medicare pdfs. Glossary of health insurance terms health insurance for. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into. This limit never includes your premium, balance billed charges or health care your health insurance or plan doesnt cover. Some people can get health insurance through a group health plan offered by their employer or their. Also called an exchange, a health insurance marketplace is a place where you can buy health coverage online. Those can be found in your insurance policy or certificate. Consumer glossary national association of insurance.
These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. A glossary of technical terms on the economics and finance of health services. Some of these terms also might not have exactly the same meaning when medicare basics. Mcqa glossary of terms texas department of insurance. If youre looking for a free download links of glossary of insurance and risk management terms pdf, epub, docx and torrent then this site is not for you. Medical insurance glossary of terms 2018 health medicare pdfs. Glossary of insurance terms this list is not meant to be all inclusive, but should help with your understanding some insurance terms used in our website.
This glossary is intended as a general aid to help you understand some of the commonly occurring phrases and jargon used in the insurance world. 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. Agent the insurance company representative who sells policies on behalf of the insurer. Health care terminology glossary aaahcc american accreditation health care commission aahcc accreditation is an important quality seal of approval for provider networks and managed care organizations. Actual cash value is the fair market value of your vehicle. Understand all of the health insurance terms that are important to know throughout the enrollment process. If you come across a term youre not sure about, check the glossary at the back of the book. Please read your official policy for full details about coverages.
On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. This az pocket guide to understanding financial terms is just one of the achievements of ebss partnership with nala. Health maintenance organization hmo a type of health benefit plan that usually limits coverage to care from doctors who work for or contract with the hmo. These definitions do not alter or modify the terms of any insurance contract. Other terms and more information are in your insurance policy or certificate. The maximum amount of benefits a health insurance plan will pay over a persons lifetime. Glossary of health coverage and medical terms this glossary defines many commonly used terms, butisnt a full list. Military health system mhs health care glossary serves as the official repository and consolidated reference as a secondary source for terms and definitions used within the mhs. When making decisions about health coverage, consumers should know the specific meanings of terms used to. These glossary terms and definitions are glossary of health coverage and medical.
If you have any questions about the use or meaning of a term or expression in any particular product or literature, you should raise them with the provider concerned. Glossary of health insurance terms national health policy forum. This glossary has many commonly used insurance and medical terms, but isnt a full list. 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. If you have any questions about the use or meaning of a term or expression in any particular product or literature, you. The international shipping and marine transport industry is full of unique shipping terms and shipping abbreviations.
Claim a statement that includes the health care services you have received and what the services cost. These general definitions are provided for educational purposes. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. A federal and statefunded health insurance program for lowincome children, elderly, blind or disabled people. Broker a licensed professional who helps businesses and individuals obtain a health plan. This glossary has many commonly used terms, but isnt a full list. This glossary of health insurance and healthcare terms defines commonly used terms, is intended for educational purposes and may differ from language used in your policy. Glossary of health coverage and medical terms just plain clear. Health care terminology glossaryaaahcc american accreditation health care commission aahcc accreditation is an important quality seal of approval. This is the share of the cost you pay for health care received after you meet your deductible. Weve curated a list of life and health insurance terms and their definitions to help you better understand the confusing language of insurance. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in. Insurance definitions, dictionary, glossary and terms.
But once you meet your out of pocket maximum, your insurance pays 100% of qualifying costs. Maryland health connection marylands official health insurance marketplace. After paying 80 percent of losses up to a specified ceiling, the insurer starts paying 100 percent of losses. Health coverage and medical terms gtm payroll services. Health care services that your health insurance or plan doesnt pay for or cover. A company owned solely or in large part by one or more non insurance entities for the primary purpose of providing insurance. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. Medical insurance glossary of terms 2018 health medicare. Glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. If you qualify for a tax credit or subsidy to help pay for your coverage, you must buy your health plan through the federal health insurance marketplace, located at healthcare. Having launched it originally in 2004 we have now updated it with modern terminology to meet with the increasing demand for the book.
Glossary of insurance policy terms the oecd has produced a unique glossary of insurance policy terms which covers selected topics ranging from insurance policy regulationsupervision to general trade issues. Glossary of health insurance terms blue cross and blue. Glossary of health insurance and medical terms page 1 of 4 glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. The plan must also limit the total amount of out of pocket cost. The federal poverty level fpl is the set minimum amount of. Glossary of health insurance and medical terms this glossary has many commonly used terms, but it isnt a full list. Glossary of health insurance terms by rmhp in comparing and evaluating health plan options, the industry terminology can be a little overwhelming. In the united states, this level is determined by the department of health and human services. With this publication, the qtmhc has endeavoured to develop a practical resource to enhance the skills of interpreters who do not have access to mental health training and for those working in regional settings. Health insurance a contract that requires your health insurance company to pay some or all of your health care costs in exchange for a premium.
For example, if a health care service is covered at a 20 percent coinsurance, you would pay 20 percent of the covered costs, and the plan would pay 80 percent. Access a patients ability to obtain medical care determined by factors such as the availability of medical services, their acceptability to the patient, the location of. Download glossary of insurance and risk management terms. Glossary of health insurance terms blue cross and blue shield of. See page 4 of the pdf download for an example showing how deductibles, coinsurance and outofpocket limits work together in a real life situation.
A company owned solely or in large part by one or more non insurance entities. This page provides a glossary of insurance terms and definitions that are commonly used in the insurance business. Glossary of health coverage and medical terms page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan. Every industry has its own jargon, and the health and life insurance business is no exception. Most had little or no experience with health insurance terminology. Some terms may have multiple and varying definitions based on the context and primary source of authority. Please refer to your policy or certificate of insurance for exact definitions of terms and coverage provisions. Glossary of health coverage and medical terms omb control numbers 15452229, 12100147, and 09381146 page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list.
Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. When reading the definitions, please keep in mind that this glossary is provided as a guide only curated from various sources. Department of health and human services hhs dependent coverage. Health insurance glossary understanding health care terms. Glossary of health coverage and medical terms this glossary has many commonly used terms, but isnt a full list. Jan 07, 2014 this document contains a list of commonly used health insurance terms and their definitions to help consumers better understand how health insurance coverage works. This document contains a list of commonly used health insurance terms and their definitions to help consumers better understand how health insurance coverage works. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance. Prioritization, costing and the medium term time horizon, world health organization, western pacific regional office, undated. Glossary of health insurance terms as you explore our site, you may come across an unfamiliar word or term. For health insurance, it is a percentage of each claim above the deductible paid by the policyholder. Glossary of health insurance terms health insurance for employers.
The definitions in this glossary are developed by the naic research and actuarial department staff based on various insurance references. Ambulatory services health services provided to members who are not confined to a health care institution. If there is any conflict between these definitions and the provisions of the. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download. Weve developed a glossary of health care terms we hope will help you. A form of corporation, allowed by the irs for most companies with 35 or fewer shareholders, which enables the company to enjoy the benefits of incorporation but be taxed as if. The main purpose of the dictionary is to strengthen the means of communication between spanish speaking populations and the health workers serving. This englishspanish dictionary of health related terms was developed for the use by health care personnel and other professionals working with the latino population in the united states. And these are used every day to describe everything from modes of transport, units of measure, pricing structures, incoterms and much more. May 26, 2018 medical insurance glossary of terms 2018. These glossary terms and definitionsare intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. 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. Insurance glossary understanding common insurance terms.
A comprehensive law passed in 2010, aimed at reforming americas health care system to improve access and affordability for more americans. Different insurance providers may have varying ideas about what constitutes full coverage, but it will always include the insurance legally required by your state. Its what you could expect to receive if you sold your car to a private buyer, and its what an insurer will base your payment on if your car is stolen or totaled. A complaint that you communicate to your health insurer or plan. A form of insurance that pays damages equal to the replacement value of damaged property minus. An insurance plan thats certified by the health insurance marketplace, provides essential health benefits, follows established limits on costsharing like deductibles, copayments, and outofpocket maximum amounts, and meets other requirements under the affordable care act. Health care services that help a person keep, learn or. Nov 01, 2017 when it comes to choosing the best automobile insurance, knowing industry terms and language gives you a good head start.
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