The set dollar limit that paid by you or your employer to a health maintenance organization (HMO). This amount must be paid to the HMO no matter how much or little you use the services provided by the plan.
Treatment that is organized for you by multiple health care providers. Accountable Care Organizations and medical homes are two typical examples of coordinated care.
An insurance company or health maintenance organization (HMO) that sells health insurance policies.
Case management is a system utilized by insurance companies and employers to make sure individuals are getting the proper health care services for a reasonable cost. It is a method of managed care that combines a process of assessment, facilitation, planning, care coordination, evaluation, and advocacy for the individual of family’s best health care options.
According to some insurance companies, plans that only cover specific kinds of costly medical services, such as hospitalization, are considered catastrophic. Other insurance companies refer to plans with a high deductible as catastrophic.
Certificate of Insurance
A printed description of benefits and coverage provisions to make a contract between the insurer and the policy-holder. It outlines what benefits and services are and are not covered and dollar limits.
CHIP (Children’s Health Insurance Program)
A state and government-funded program providing health insurance to low-income children under age 19, and in some states pregnant women who cannot afford an individual health plan and have too high an income for Medicaid. Read this article for more information.
Chronic Disease Management
A form of managing care for illnesses which includes screenings, check-ups, care monitoring and coordination, and patient education. It intends to improve quality of life while reducing medical treatment expenses by preventing or minimizing the effects of a disease.
A medical bill that your health care provider sends to your health insurer to be paid for services that are not covered. Read this article for more information.
A federal law that allows some individuals to keep their group health coverage for a short time after their employment has ended, they have lost coverage as a dependent of an employee, or another such event. COBRA coverage makes individuals pay 100% of their premiums, including the portion formerly paid by the employer and the administrative fee. For more information read this article.
The percentage of allowed charges that you must pay for covered medical services. Typically, these charges occur after a deductible has been met, and it is referred to as a copayment in some health policies.
The ability, in certain states, to convert coverage from your employer to an individual plan when you lose eligibility for a group plan. Family members who were dependents may also qualify for individual plans if they were dropped from an employer’s group policy.
A predictable, flat rate charged for a service covered by your health insurance plan. A common service that can require a copayment is a covered doctor’s office visit, which are usually $10 under an HMO.
The portion of expenses that your insurance covers that you must pay out-of-pocket. Cost sharing can include deductibles, copayments, and coinsurance, or similar charges, but does not include premiums, balances due to out-of-network providers, or services that are not covered. Cost sharing includes premiums for Medicaid and CHIP.
Health insurance coverage from any of the following: individual health insurance, group health insurance, student health insurance, Medicaid, Medicare, CHIP, the Federal Employees Health Benefits Program, the Peace Corps, Public Health Plans, or a state high risk pool. Having proof of previous creditable coverage will shorten a pre-existing condition exclusion period through an employer group plan.
1. HealthInsurance.org, “Health insurance glossary”. http://www.healthinsurance.org/glossary/
2. HealthCare.gov, “Glossary – C”. http://www.healthcare.gov/glossary/c/index.html
3. Case Management Society of America. “Definition of Case Management”. http://www.cmsa.org/Home/CMSA/WhatisaCaseManager/tabid/224/Default.aspx