Regular Medical Insurance Dictionary Definition
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Regular Medical Insurance Dictionary Definition

The period set for you to choose from the available health plans, usually once a year. How we check the type and extent of care you receive. This includes examining the environment for your care and its medical necessity. Examples include pre-approvals, case management, related reviews, or appropriate discharge planning. A health insurance plan that meets the minimum basic coverage requirements of the Affordable Care Act. These plans are offered by Blue Cross and Blue Shield of Illinois or a health insurance agent. These plans are not available in the health insurance market and are not eligible for the premium tax credit. If you qualify for a premium tax credit and want to use it, you will need to sign up for a trade-in plan. Since 2015, if an employer with at least 50 full-time equivalents does not offer affordable health insurance and an employee uses a tax credit to pay for insurance through a health insurance market, the employer must pay a fee to cover the cost of the tax credits. The ongoing amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or annually. The premium may not be the only amount you pay for insurance coverage.

Typically, you also have a co-payment or deductible on top of your premium. A discount that reduces the amount you have to pay out of pocket for deductibles, co-insurance and co-payments. You can get this discount if your income is below a certain level and you choose a Silver category insurance plan. If you are a member of a government-approved tribe, you may be eligible for additional cost-sharing benefits. Medical cost-sharing groups (also called ministries of health) are a group of like-minded people who help each other pay for their medical bills. These groups resemble a health regimen. However, instead of paying a monthly premium bill, contributions are paid into a shareable account. This way, if a member needs health funds, the shared money can be used to cover costs.

An income level issued annually by the Department of Health and Social Services – is used to determine eligibility for certain programs and benefits. FPL is used to determine the amount of tax credit to which you are entitled to offset the cost of purchasing health insurance. A period outside the open enrolment period during which you can take out health insurance. You are usually entitled to a special registration period of 60 days after certain life events that change your marital status (e.g. marriage or birth of a child) or the loss of other health insurance. Medical conditions or specific circumstances not covered by a health care plan. A requirement under the Affordable Care Act that health plans must allow you to purchase some form of insurance regardless of health status, age, gender or other factors. A cap on the total lifetime benefits you can receive from your insurance company for certain conditions. A health plan may have an overall lifetime limit on benefits (such as a lifetime cap of $1 million) or restrictions on certain benefits (such as a lifetime cap of $200,000 for organ transplants or gastric bypass surgery per life), or a combination of both.

After reaching a lifetime period, the insurance plan no longer pays covered benefits. Under the Health Act, lifetime restrictions on essential health services such as emergency services and hospitalization are no longer allowed. Health insurance is full of terms you may not be familiar with. To help you better understand health insurance, here is a list of the most commonly used terms and definitions in healthcare. Services for the initial outpatient treatment of an acute illness, usually in a hospital. Most health plans have specific guidelines defining emergency medical care. Most of what you have to pay for covered services during a plan year. After spending this amount on deductibles, co-payments and co-insurance, your health plan pays 100% of the cost of covered benefits. For plans that cover more than 1 person, individual expenses count towards the family maximum in the pocket. Once the maximum family amount is reached, the plan pays 100% of the cost of covered benefits for all members of your plan. The maximum amount out of pocket does not include your monthly premium payments or anything you spend on services your plan doesn`t cover.

Federal legislation outlining the rules and requirements that employer-sponsored group insurance plans, insurance companies, and managed care organizations must follow to provide health insurance coverage to individuals and groups. Health items or services covered by an insurance plan. Your insurance plan may sometimes be called a “benefits plan.” The health insurance swap will include a disastrous plan option. Disastrous plans have lower premiums, but don`t start paying until you`ve paid a certain amount for covered services or only cover more expensive levels of care, such as hospitalizations. Disastrous diets are an option that should be considered for young adults and individuals for whom coverage would otherwise be prohibitively prohibitive. The doctor you choose as your primary source of medical care. Your PCP coordinates all your medical care, including hospital admissions and referrals to specialists. Not all health plans require a PNP.

Drug infusion treatments are often used for chronic “maintenance diseases” such as asthma, immunodeficiency or rheumatoid arthritis. Drugs are often covered by the medical benefit of your health plan, not by the benefit of drugs. Where you receive this care may change your expenses. Check the cost of treatment of infusion medications. Certain benefits are included in each insurance plan. As of 2014, most insurance plans you can choose from – whether you`re buying from the health insurance market or going directly to the insurance company of your choice – include many benefits designed to guarantee coverage for basic health conditions. Services provided by a physician or other health care provider with a contractual agreement with the insurance company and paid for at a higher level of benefits. Plans that offer coverage if you have a serious medical condition that prevents you from purchasing private insurance.

The new legislation introduced the pre-existing condition insurance plan. Some states also have their own high-risk pool plans. An insurance plan may limit the amount of money it pays in a year for a particular treatment or service, or for all benefits provided in a year. Glossary of Health Terms Health insurance is full of terms you may not be familiar with. To help you better understand health insurance, here is a list of the most commonly used terms and definitions in healthcare. ABCDEFGHIJKLMNOPQRSTUVWXYZ An Affordable Care Act A comprehensive law passed in 2010 that aims to reform the U.S. healthcare system to improve access and affordability for more Americans. Eligible expenses The maximum amount that a health insurance plan reimburses a physician or hospital for a particular service. Annual deductible The amount you must pay annually before reimbursement begins through your health insurance plan. The deductible does not apply to prevention services. An insurance plan may limit the amount of money it pays in a year for a particular treatment or service, or for all benefits provided in a year. B-Benefits Health services or services covered by insurance.

Your insurance plan may sometimes be called a “benefits plan.” C catastrophic plan The health insurance swap will include a catastrophic plan option. Disastrous plans have lower premiums, but don`t start paying until you`ve paid a certain amount for covered services or only cover more expensive levels of care, such as hospitalizations. Disastrous diets are an option that should be considered for young adults and individuals for whom coverage would otherwise be prohibitively prohibitive. Application Form A form that you or your doctor complete and submit to your health insurance plan for payment. Right A detailed invoice for services provided to a member. COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. This federal legislation requires group health plans to allow insured employees and dependents to maintain their group coverage for a specified period of time after an eligible event that results in the loss of group health insurance. Eligible events include reduced hours of work, termination of employment, birth of an aging dependent child, application for health insurance, death or divorce of an insured employee. Coinsurance The percentage of the cost of covered health care or prescription drugs that you pay for after paying your deductible.

You pay 100% of the total eligible amount until you reach your deductible. Contract hospital A hospital that has contracted with a particular health plan to provide hospital services to plan members. Copay (also known as a co-payment) The fixed dollar amount you pay for a covered health service at the time of treatment or when you pick up a prescription drug. Reduced cost-sharing (CSR) A discount that reduces the amount you have to pay out of pocket for deductibles, co-insurance and co-payments. You can get this discount if your income is below a certain level and you choose a Silver category insurance plan.

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