Health insurance terminology Flashcards
Premium
The amount the policy holder pays the insurance company to keep the policy in effect
Subscriber/policy holder
The person who owns the policy
Insured/Beneficiaries
The person(s) covered under the insurance policy
Guarantor
Person who is responsible for the out of pocket expenses.
In network/participating provider
Provider who has a contract with the insurance company. They accept the allowed amount by the insurance and takes it as full payment.
Out of network/Non participating provider
Not under contract. can balance bill
Balance bill
Patient/insured is billed the difference between what the services cost and what insurance will pay
Allowed amount
The amount that the participating provider and insurance company agrees upon.
UCR
= The maximum amount an insurer will pay for a given service.
Deductible
Amount that must be paid before an insurer will cover expenses. In order for benefits to begin, the patient must pay their deductibles
RENEWS every year
Coinsurance
a percentage that the patient is responsible for paying
co-payment
A set amount that must be payed by the insured for a specific service.
pre-existing condition
Medical condition that existed before obtaining health insurance
Exclusions
Items that may not be paid for by insurance.
Precertification
Confirming that a service is a benefit covered under the policy
