Health Insurance Terms

Over the course of your life you have probably already been to a doctor’s office many times. However, your parents or guardians were probably handling your insurance and the payments.  As you venture off on your own you will need to be familiar with some of the terms you will soon hear.

Accumulation Period – Period of time during which a person, who has insurance, incurs medical expenses towards the satisfaction of the deductible.

Ancillary Products – Extra health insurance products you can add to your existing plan for an additional fee. Most common products include vision and dental insurance.

Annual Limit – A dollar limit, set by the insurance provider, indicating the maximum amount the provider will pay for claims made within the plan year.

Benefit – Amount insurance company will pay to individual to cover medical expenses.

Claim – Request by individual or doctor for insurance to make a payment.

Copay – A fixed amount paid by the patient with insurance paying the balance of the charges.

Deductible – Amount insured must pay annually for medical expenses before the insurance policy will begin paying.

Effective Date – The date when your health insurance coverage begins.

Eligibility Requirements – Set of requirements that must be met for an individual or group to be eligible for coverage.

Enrollment Period – A set time period in which an employee can enroll in an employer or group health insurance plan. Check with your manager or HR department to ensure you don’t miss the enrollment period.

Exclusions – Specific treatments or conditions that a health insurance plan will not cover.

HIPAA – The Health Insurance Portability and Accountability Act (1996) requires specific privacy rules and practices for health care providers and health insurance companies. HIPAA helps to protect the patient’s identity and privacy.

Maternity Coverage – The insurance provider covers all or most of the costs involved during a woman’s pregnancy.

Premium – Amount paid each month for health insurance coverage.

Preventive Care – Care administered to prevent and detect disease. This care is not for a specific complaint.

Provider – An individual or institution that provides medical services.

Rider – An option to expand your basic insurance plan for an increased premium.

Temporary Partial Disability – Term used to describe an individual who is unable to work at full capacity due to an injury, but is expected to fully recover.