health coverage 2 Flashcards
What is a deductible?
An amount you could owe during a coverage period (usually one year) for covered health care services before your plan begins to pay. An overall deductible applies to all or almost all covered items and services. A plan may also have separate deductibles for specific services.
For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible.
What is a diagnostic test?
Tests to figure out what your health problem is.
For example, an x-ray can be a diagnostic test to see if you have a broken bone.
What is Durable Medical Equipment (DME)?
Equipment and supplies ordered by a health care provider for everyday or extended use. DME may include oxygen equipment, wheelchairs, and crutches.
What is an emergency medical condition?
An illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn’t get medical attention right away.
What is emergency medical transportation?
Ambulance services for an emergency medical condition. Types may include transportation by air, land, or sea.
What are emergency room care / emergency services?
Services to check for an emergency medical condition and treat you to keep it from getting worse. These services may be provided in a licensed hospital’s emergency room.
What are excluded services?
Health care services that your plan doesn’t pay for or cover.
What is a formulary?
A list of drugs your plan covers, which may include how much your share of the cost is for each drug.
For example, a formulary may include generic drug and brand name drug tiers.
What is a grievance?
A complaint that you communicate to your health insurer or plan.
What are habilitation services?
Health care services that help a person keep, learn or improve skills and functioning for daily living.
What is health insurance?
A contract that requires a health insurer to pay some or all of your health care costs in exchange for a premium.
What is home health care?
Health care services and supplies you get in your home under your doctor’s orders.
What are hospice services?
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
What is hospitalization?
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
What is hospital outpatient care?
Care in a hospital that usually doesn’t require an overnight stay.
