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Health Insurance Glossary I-Z

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Do You Qualify For A Subsidy?


Find out if you qualify for a government subsidy under Obamacare. Millions of Americans will have their insurance rates reduced under the new health care law. Learn how much you could save with our simple calculator.




I

Indemnity Contracts:
Policies that provide a set amount per day during confinement in a hospital or long-term facility.

Indemnity Insurance Plans:
Insurance plans that pay for medical services provided by any hospital or doctor. Also known as "Fee-for-service plans" and comprehensive plans

Intermediate Nursing Care:
Health care for individuals who need minimal supervision.

Intermediary:
The insurance company of the Department of Health and Human Services responsible for paying patients and health care providers.

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J

Joint Commission on Accreditation of Health care Organizations (JCAHO):
responsible for the accreditation of health care organizations after careful evaluation of the services provided to determine quality care.

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L

Limited Health Insurance:
Policies that cover specific injuries and illnesses.

Long-Term Care:
Care for patients with chronic diseases or disabilities including home health care, adult day care, hospice care, respite care, and intermediate care but not hospital care.

Long-Term Care Insurance:
This type of insurance covers the costs of nursing home care, which can be several thousand dollars each month. Long-term care is usually not covered by health insurance except in a very limited way.

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M

Major Medical Insurance:
Insurance that covers the expenses related to hospitalization. Provides a fixed amount of money to be used throughout the lifetime of the insured.

Managed Care:
Health plans that control the cost, use and quality of the health care system. These plans combine physicians, hospitals, and insurance plans into a single network. All HMOs and PPO, and many fee-for-service plans, have managed care.

Maximum Out-of-Pocket:
The most money you will be required pay a year for deductibles and coinsurance. It is a stated dollar amount set by the insurance company, in addition to regular premiums. It limits the amount you will have to pay in a given year for health care services.

Medicaid:
The federal health insurance program for low-income Americans.

Medical Savings Accounts (MSA plans):
Government-approved plans, designed to help small business owners, the self-employed, and those employed by small businesses, to save on medical insurance by purchasing a high deductible managed care plan, and saving for deductible expenses in a tax-exempt savings account, along the lines of an I.R.A.

Medicare:
The federal health insurance program for people 65 and older or people who are totally disabled. Hospital Insurance (or Plan A) under Medicare, which is available to seniors when they reach the age of 65, covers in-patient hospital care, skilled nursing care, home health care, and hospice care. Medical Insurance (or Plan B) under Medicare, a voluntary program, covers physician service, physical therapy, ambulance expenses, and out-patient services. You are required to pay a premium for the services under Plan B.

Medicare Supplemental Insurance:
Also known as "Medigap". This type of coverage helps seniors cover the costs of "gaps" in the coverage provided by Medicare.

Medigap:
See "Medicare Supplemental Insurance" above.

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N

National Committee for Quality Assurance (NCQA):
Assesses the quality of managed care plans. Publishes information about the quality, accreditation and performance of health plans so consumers can make informed decisions while choosing health insurance.

Non-cancelable Policy:
A policy that guarantees you can receive insurance, as long as you pay the premium. It is also called a guaranteed renewable policy.

Nursing Home Care:
Care an individual receives in a nursing home which includes custodial and nursing services.

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P

Peer Review:
A group of federally employed doctors who evaluate Medicare services provided at certified hospitals.

Point of Service (POS):
A Managed Care health plan that encourages its members to seek care from certain providers by offering them more reimbursement. Care sought outside the network, however, is still covered just at a lower reimbursement level. Some plans include a POS policy into an already existing HMO health plan.

Pre certification:
The approval an insurance company must give before certain services can be obtained.

Preexisting Condition:
A health problem that existed before the date your insurance became effective. Some insurance policies deny coverage for pre-existing conditions entirely others do only for a set period of time.

Preferred Provider Organization (PPO):
A combination of traditional fee-for-service and HMO health plans. There is a network of providers that have agreed to provide services for a discounted rate. When you use the doctors and hospitals that are part of the established PPO network, a large part of your medical bills are covered. You can use other doctors outside the network, but at a higher cost.

Premium:
The amount you or your employer pays in exchange for insurance coverage.

Preventative Care:
Any service that focuses on prevention such as mammograms, immunizations, shots, physical exams and diagnostic tests.

Primary Care Physician (PCP):
Usually your first contact for health care. This is often a family physician or internist, but some women use their gynecologist. A primary care physician monitors your health and diagnoses and treats minor health problems, and refers you to specialists if another level of care is needed.

Provider:
Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care.

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R

Respite Care:
Temporary care provided to a terminally ill patient allowing a family member who may be the primary caretaker to take a break from nursing duties.

Rider:
An attachment to a policy explaining any changes or additions made to a standard insurance form.

Risk Contract:
An arrangement in which a health provider offers a range of health services to a group of patients for a pre-paid amount.

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S

Self-Employed Health Insurance:
Insurance for the self-employed is often more expensive and more limited, however, similarly to all "small business health insurance", it offers certain tax advantages.

Short Term Health Insurance:
A type of health insurance plan purchased to cover gaps in coverage, which can occur between jobs, after a move, etc.

Small Business Health Insurance:
Also known as "small group health insurance", this type of coverage is available to small businesses with between 2 and 50 employees. It often offers less expensive premiums, tax advantages to business owners, and in most cases, coverage cannot be denied.

Stop-Loss Provision:
The point when the insurance company will begin to pay 100% of accrued medical expenses.

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T

Third-Party Payer:
Any payer for health care services other than you. This can be an insurance company, an HMO, a PPO, or the Federal Government, in the case of Medicare or Medicaid coverage.

Travel Health Insurance:
Coverage purchased to cover travelers abroad.

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U

Usual, Customary and Reasonable Charges:
The price for medical services the insurance company determines to be the average charge for similar procedures in a given geographical location.





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This internet site provides information of a general nature for educational purposes only and is not intended to be legal advice. We make no guarantees as to the validity of the information presented. Your particular facts and circumstances, and changes in the law, must be considered when applying insurance law. You should always consult with a competent insurance professional licensed in your state with respect to your particular situation.