Below are some common terms used in discussion of insurance. When deciding on what insurance to purchase, you may want to refer to this glossary of insurance terms.
- Accident
- An unexpected event that causes injury.
- Allowable Charges
- The charges agreed to by the Preferred Provider Organization (PPO) for specified covered medical treatment, services and supplies.
- Benefits
- The money the insurance company pays the health care provider for medical services provided to you if you become ill or injured.
- Claim
- A request by you for the insurance company to pay medical expenses that are covered under the insurance policy. If the provider of a medical service is in network, they will file the claim for you.
- Coinsurance
- A provision of the insurance by which the covered person and the insurance carrier share in a specified ratio the eligible hospital or medical expenses resulting from a sickness or accident, (e.g. 80%:20%; the insurance carrier paying 80%, the insured person paying 20%). Coinsurance typically comes after the deductible, but not always.
- Coverage
- The conditions for which the insurance company will pay.
- Copayment
- A specified dollar amount a Covered Person must pay for specified services, typically for office visits, urgent care, and ER visits.
- Covered Person
- A Covered student and his or her dependent(s) insured under the Policy.
- Deductible
- The cumulative amount that you must pay annually before benefits will be paid by the insurance company. If the insurance policy indicates a "$250 deductible," the insurance company pays as agreed after you pay the first $250.
- Provider
- A licensed practitioner providing medical expertise and services within the scope of his or her license and practice.
- Effective Date
- The date insurance coverage begins.
- Eligible Expenses
- An expense defined in a health plan as being covered and not listed in the exclusions section.
- Essential Health Benefits
- A set of health care service categories that must be covered by certain plans, starting in 2014. The complete list of categories can be viewed at HealthCare.gov - Essential Health Benefits.
- Exclusions
- Specified conditions or circumstances for which a policy does not provide benefits.
- Expiration Date/ Termination Date:
- The date that insurance coverage ends.
- Explanation of Benefits (EOB):
- The statement you receive from the insurance company showing the services, amounts paid by the plan and total for which you are being billed.
- Identification Card:
- A card given to you that identifies you as a member of a particular health insurance plan. The card must be presented when seeking treatment, as it contains identifying information specific to you and your plan in order to process claims.
- Insurance
- A system under which individuals, businesses and other organizations, in exchange for a premium, are promised payments for losses resulting from certain dangers as specified in a contract.
- Insurance Policy
- The legal document issued by the company to the policyholder, which outlines the terms and conditions of the insurance; also called a "contract."
- Insured
- A person or organization covered by an insurance policy.
- In-Network
- Defines providers or health care facilities that are contracted with a particular network and have negotiated discounts with the participants of that network.
- Major Medical
- A plan that provides basic medical coverage, typically with a high deductible.
- Medical Necessity/Medically Necessary
- Services, supplies, or treatment for particular diagnoses that are within the standard of care in the medical community and/or as defined by CDC.
- Open Enrollment:
- Time period when students are eligible to enroll or change coverage for any reason.
- Out-of-Pocket Costs:
- The total you pay out of your pocket for a policy year. These costs include the deductible, co-insurance and amounts considered by the insurance company to be above the "Usual and Customary charges.”
- Out-of-Network
- Defines providers or health care facilities that are not contracted with a particular network and do not have negotiated rates or discounts with that particular network.
- Pharmacy:
- A business where drugs approved by a doctor are legally sold.
- Pre-existing Condition:
- A medical condition that was diagnosed and/or required treatment during a fixed period of time, usually 3 or 6 months, before you purchased your insurance policy.
- Preferred Provider Organization (PPO)
- A type of managed care health insurance plan that utilizes a network of physicians and facilities contracted by the insurance carrier to provide services for a negotiated price bound by contract. Utilizing PPO providers helps to keep the out of pocket costs lower to you overall and claims costs lower to the insurance plan.
- Policy Term:
- The length of time a health policy provides benefits to a covered person.
- Premium:
- The price you pay for your insurance policy.
- Usual and Customary Charge/Reasonable and Customary
- The routine charge for a medical service by similar professional medical providers in the same geographical area. You may be required to pay an amount above the Usual and Customary charge for an out-of-network provider, if that provider charges more than other providers for the same service.
Hours
Spring: Monday–Friday: 8:30 a.m. to 4:30 p.m.
Summer: Monday–Friday: 8 a.m. to 4 p.m
Location
Wardenburg Health Center, 2nd floor