| A | B |
|---|
| indemnity | fee-for-service |
| insured | policyholder |
| premium | monthly fee paid by policy holder |
| deductible | ammount paid by policyholder before insurance pays |
| coinsurance | percentage paid by policy holder "cost sharing" |
| CMS-1500 form | universal claim form submitted for reimbursement |
| exclusions | illnesses or injuries not covered by policy |
| preexisting condition | condition that existed before the policy went into effect |
| managed care plan | group of providers who share financial risk |
| Medicare | provides benefits to individuals 65 or older and those with disabilities |
| Medicaid | coverslow-income individuals and certain disabled individuals |
| TRICARE | U.S. military's comprehensive healthcare program for active-duty personnel and family members |
| CHAMPVA | health benefits for those who are retired and permanently disabled due to service related or death during service |
| Disability insurance | pays policyholder a specific sum of money in place of income if they can't work. |
| social security disability insurance | individual who become unable to work paid by SSA |
| workers' compensation | insurance pays workers who are injured or disabled while on the job |
| flexible spending account | cost of the plan is deducted from employees earnings before taxes |
| health insurance exchange | developed to create a more organized and competitive health insurance market |
| Consolidated Omnibus Budget Reconciliation Act | the right to provide temporary continuation of health coverage at group rates |
| birthday rule | helps determine which health plan is considered primary when dependents are covered by two different plans |
| coordination of benefits | "overinsurance" |
| maintenance of benefits | allows patients to receive benefits from all health insurance plans, while maintaining responsibility for coinsurance, copay |
| balance billing | difference between the charged amount and the allowable amount |
| participating provider | one who contracts with the third-party payer and agrees to rules and regulations of the insurance company |
| copayment | set amount that is the patient's responsibility |
| covered expenses | medical procedures the health plan agrees to pay |
| Primary Care Physician | gate-keeper |
| provider | doctor, nurse, dentist, hospital or clinic that provides medical care |
| third-party payer | any payer for healthcare services other than the patient |
| group health insurance | insurance policy covering a group of people |
