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Deductible
Cost-sharing arrangement between an insured person and health insurance company in which the insured person will be required to pay a fixed dollar amount of covered expenses each year before the health insurance company will reimburse for covered health care expenses. Generally, an insured person is responsible for a deductible each calendar year.
Dental Maintenance Organization
An organization like an HMO which provides only dental care.
Dentist-Consultant
A licensed dentist who understands the underwriting intent of dental plan language as well as the accepted standards of dental practice, and who advises insurers as to the appropriateness of dental treatment.
Disenroll
Ending a person's health care coverage with a health plan.
Effective Date
The date health insurance coverage begins.
Eligible Dependent
A dependent of a covered person (spouse, child, or other dependent) who meets all requirements specified in the contract to qualify for coverage and for who premium payment is made.
Emergency Care
Care given for a medical emergency when you believe that your health is in serious danger - when every second counts.
Employer Group Health Plan (GHP)
A GHP is a health plan that gives health coverage to employees, former employees, and their families, and is from an employer or employee organization.
Enroll
To join a health plan.
Episode of Care
The health care services given during a certain period of time, usually during a hospital stay.
Exclusion Period
A period of time when an insurance company can delay coverage of a pre-existing condition. Sometimes called a pre-existing condition waiting period.
Explanation of Benefits (EOB)
Statement sent by health plans to persons who have experienced a claim under the health plan. The explanation of benefits (EOB) details the charges for the services received, the amount the health insurance company will pay for those services, and the amount the insured person will be responsible for paying.
First Dollar Coverage
Refers to not having to meet a calendar year deductible prior to receiving reimbursement or payment for a medical service.
Fee Schedule
A complete listing of fees used by health plans to pay doctors or other providers.
Formulary
A list of certain drugs and their proper dosages. In some health plans, doctors must order or use only drugs listed on the health plan's formulary.
A - C D - F G - I J - L M - O P - R S - V W - Z | Resource Center
