Term
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Definition
| Time-dependent limitation of coverage |
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Term
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Definition
| Person covered under policy terms. |
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Term
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Definition
| Insurance carrier pays a percentage |
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Term
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Definition
| Money insured pays for medical services |
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Term
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Definition
| payment collected at office visit |
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Term
| Health maintenance organization (HMO) |
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Definition
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Term
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Definition
| Priority of medical care coverage under both parents. |
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Term
| Explanation of benefits (EOB) |
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Definition
| Summarizes reimbursements of services to you. |
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Term
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Definition
| Summarizes all benefits paid to the provider |
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Term
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Definition
| Patient gets approval for procedure/visit |
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Term
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Definition
| Payment sent to provider/patient |
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Term
| Primary care provider (PCP) |
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Definition
| First medical practitioner caring for patient. |
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Term
| Managed care organization (MCO) |
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Definition
| Assumes health care needs for an enrollee group |
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Term
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Definition
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Term
| Types of managed care organizations |
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Definition
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Term
| Exclusive provider organization (EPO) |
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Definition
| Enrollee obtains service from provider network |
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Term
| Integrated delivery systems (IDS) |
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Definition
| Enrollee obtains service from affiliated group |
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Term
| Health Maintenance organization (HMO) |
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Definition
| Enrollee obtains services from fixed fee provider |
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Term
| Point of service (POS) Plan |
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Definition
| Enrollee has freedom to obtain an HMO/non HMO |
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Term
| Preferred Provider Organization (PPO) |
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Definition
| Enrollee obtains service from discount fee provider |
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Term
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Definition
| Enrollee chooses traditional, HMO or PPO plans |
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Term
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Definition
| Covers hospital stay, health care and hospice |
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Term
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Definition
| Begins first day of hospital stay |
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Term
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Definition
| Covers outpatient expenses |
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Term
| Works compensation insurance |
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Definition
| Medical/paycheck insurance for injured workers |
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