Encyclopedia article covering topics such as types, principles, indemnification, the insurance industry, and controversies.
Health Insurance Terms Glossary
Benefits—Included services to which the policyholder is entitled.Claim—A bill submitted to a health insurance company or provider for payment.
Coinsurance—The amount of money, usually a percentage, that a policyholder pays for services and care. The remaining percentage or amount is the responsibility of the health insurance company.
Co-payment—The amount of money paid by the policyholder at each visit for certain medical services.
Deductible—The amount of money that will be paid out-of-pocket by the policyholder before the health insurance plan will pay. The deductible is usually an annual amount.
Disability insurance: A type of health insurance coverage that pays you when you are unable to work for an extended period because of an injury or other medical condition. Coverage can be either long-term or short-term.
Group Health Insurance—Health coverage offered through a group, usually an employer or organization, to a group of people. Group plans spread the cost among the members of the group, enabling such plans to typically cost less per person and offer broader coverage than individual health insurance plans.
Health Savings Account (HSA) —Introduced recently, this is a high-deductible health plan coupled with a personal savings account that is used to accumulate funds for qualified medical expenses.
High Deductible Health Plan—Commonly called “catastrophic health insurance,” this is a plan with a very high deductible designed to cover medical expenses above the normal parameters of basic health insurance.
Indemnity plan: A type of health insurance coverage that lets you choose your own doctors and pays for your medical expenses-either totally, in part, or up to a specified amount per day for a specified number of days. This is also known as a reimbursement plan.
Individual Health Insurance—Health coverage purchased on an individual basis rather than through a group.
Long-term care insurance: A type of health insurance that provides for skilled, intermediate, and custodial care in a private home, adult daycare setting, assisted-living facility, or nursing home.
Major medical insurance: A type of health insurance coverage that protects you against losses from catastrophic illness or injury. It provides extremely broad coverage with a very high maximum benefit.
Managed Care—Comprehensive health insurance plans provided to participating members of a health care organization. Managed care plans are organized into a network of providers, including physicians and hospitals. Common types of managed care plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans.
Network—A group of doctors and providers that work for or with a group health care organization.
Pre-existing condition—A medical condition that existed before applying for a health insurance plan. These conditions may not be covered by a plan or only covered after a certain period of time has lapsed.
Premium—The amount of money paid for a health insurance policy.
Provider—A hospital, doctor or other facility that provides medical care.
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