Health insurance coverage for expenses associated with hospital confinements, surgeries and/or medical conditions requiring a broad range of medical services and supplies
An organized way to manage costs, use, and quality of the health care system. The major types of managed care plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
The group insurance policy that explains coverage to all members of the group.
Federal and state health insurance program for low-income individuals who meet established eligibility criteria (programs vary from state to state).
Medical information justifying that the service rendered or item provided is reasonable and appropriate for the diagnosis or treatment of a medical condition or illness.
Federal health insurance program for the elderly (age 65 and older), certain disabled individuals, and those with end-stage renal disease. Medicare is administered by the Center for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA).
A supplemental insurance policy to help cover the difference between approved medical charges and benefits paid by Medicare. These plans are also known as “Medi-gap” plans.
MEDICAL SAVINGS ACCOUNT (MSA):
A tax-advantaged personal savings account used in conjunction with a high deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and co-payments.
Many insurance policies will pay only for treatment that is deemed “medically necessary” to restore a person’s health. For instance, many health insurance policies will not cover routine physical exams or plastic surgery for cosmetic purposes.
A supplemental insurance policy to help cover the difference between approved medical charges and benefits paid by Medicare. These plans are also known as “Medicare Supplement” plans.
Lying or misleading an insurance company about the facts affecting a policy. Misrepresentation is grounds for voiding a policy.
A mathematical representation of the occurrence of illnesses to a specific classification of people.