| A | B |
|---|
| Co-Payment | A predetermined (flat) fee |
| Medigap Insurance | Helps pay for costs Medicare doesn't cover |
| Deductible | Amount a person pays before insurance pays |
| Premium | What the insurance company charges for coverage |
| Prior Authorization | Requires that hospitalization or medical treatment is approved in advance |
| Co-Insurance | A percentage (after the deductible has been paid) |
| Exclusions | Medical services not covered by an individual's insurance policy |
| Lifetime Maximum | Max amount a health plan will pay during a person's lifetime |
| Explanation of Benefits | Written explanation of a claim |
| Maximum Dollar Limit | Max amount a health plan will pay within a specific time frame |
| Effective Date | Date insurance coverage begins |
| Limitations | Limit on the amt of benefits paid out for a particular covered expense |
| Stop-loss | 100% out-of-pocket is reached and insurance pays 100% |
| COBRA | Purchasing health insurance for up to 18 months with loss of a job |
| Capitation | Set dollar limit that you or your employer pay to a HMO |
