Glossary of Health Care TermsA-H · I-P · Q-Z
Auto-Enrollment – The automatic assignment of a person to a health insurance plan.
Broker – A salesperson that has obtained a state license to sell and service health plan and insurer contracts.
Claim – A request by an individual that his or her insurance company pay for medical services received.
COBRA – Federally supported health care benefits for people whose employment has been terminated, or who have experienced other circumstances that lead to loss of coverage.
Copayment – The set amount of money a health plan enrollee pays for a specific service.
Deductible – The minimum amount of out-of-pocket expenses a health care plan enrollee must pay for medical services or medication before their plan begins to cover expenses.
Employee Assistance Program (EAP) – Benefits that are designed for personal or family problems, including mental health, substance abuse and other problems.
Enrollee – A subscriber or dependent that is eligible for coverage under a certain health care contract.
Exclusions - Conditions or situations not covered under a certain contract or plan.
Fee-For-Service (FFS) – A traditional method of payment for health care services where users pay for services rendered.
Flexible Spending Account (FSA) – A plan that provides employees with the opportunity to set aside funds pre-tax for certain medical expenses.
Group Health Plan – Health coverage to employees and their families, provided by an employer or employee organization.
Health Maintenance Organization (HMO) – A type of U.S. health care coverage where subscribers are required to receive all of their health care from a provider within a given network.
Health and Human Services (HHS) – The U.S. department that is responsible for health-related programs and issues.
Health Care Provider – Providers of medical or health care.
Lifetime Limit – A cap on the benefits available during a subscriber's lifetime under a given policy.
Managed Care – Systems and techniques used to manage health care services.
Medicaid – A federal and state program that helps with medical costs for some low-income individuals and families.
Medicare – A federal program that helps cover the medical costs of elderly and disabled individuals.
Open Enrollment Period – A period during which subscribers in a health program can revise their benefits.
Patient Assistance Programs – Programs offered by pharmaceutical companies to provide free or low-cost medications to people who could not otherwise afford them.
Pre-Existing Condition – A condition or illness that you have before enrolling in a health care plan.
Preferred Provider Organization (PPO) – A type of health care plan where a group of doctors and hospitals agrees to render particular services to a group of people for a reduced cost. This type of insurance is generally more expensive than HMOs but offers subscribers more freedom to select physicians.
Premium – The amount paid to a health care company for providing medical coverage under a contract.
Preventive Care – Health care that emphasizes prevention, early detection and early treatment.
Primary Care Physician (PCP) – A "generalist" physician who, under certain health care plans, is accountable for the total health services of enrollees.
Referral – The process of referring a patient to another doctor for specific health care services.
Waiting Period – The minimum amount of time an individual must wait before becoming eligible for specific benefits after coverage has begun.
Workers' Compensation – Insurance that covers employees who get sick or injured on the job.
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