O


Open Enrollment Period

The time period, typically once per year, where you can apply for a new or different health insurance policy from those available through your insurer.

Open-Ended HMO

HMO plans that do not restrict access to out of network provider, with provided coverage for those services, and payment under an indemnity plan.

Out-Of-Network

Physicians, hospitals, and other providers of medical care that are not included in the network designated by your health insurance plan. Depending on the type of plan you have, out-of-network costs may not be covered, or only covered partially by your insurer. Usually these plan are HMOs and PPOs, and PPOs offer more potential coverage for out-of-network visits, as well as not needing a referral to see an out-of-network physician.

Out-Of-Pocket Costs

Expenses for health care services that are not paid for by insurance companies. Out-of-pocket costs include copayments, coinsurance, and deductibles for services that are covered, in addition to the charges that are not covered.

Out-Of-Pocket Limit

The annual maximum you must pay for covered health care services, which usually includes copayments, coinsurance, and the deductible. Different plans have different ways of defining out-of-pocket limits, some placing limits on certain types of services. Medicaid and CHIP include premiums in the annual out-of-pocket limit.

Outpatient

Receiving medical services, such as surgery, without staying overnight in a hospital or inpatient facility. Some insurance companies have outlined a list of procedures and exams that they will not cover unless they are done on an outpatient basis. Outpatient also describes facilities where procedures are performed, the same as an ambulatory facility.

 

Sources:

1. HealthInsurance.org, “Health insurance glossary”. http://www.healthinsurance.org/glossary/

2. HealthCare.gov, “Glossary – O”. http://www.healthcare.gov/glossary/o/index.html