Understanding insurance terminology made simple for Oklahoma families and businesses
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Schedule an AppointmentNavigating the world of health insurance can be confusing. This glossary defines a wide range of common and advanced terms to help you better understand your plan and make informed decisions about your healthcare.
A group of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients.
The percentage of total average costs for covered benefits that a plan will cover.
An arrangement in which an employer hires a third party to deliver administrative services.
A comprehensive healthcare reform law enacted in March 2010.
The maximum amount a health plan will pay for a covered health care service.
A formal request to your health insurance company to review a decision that denied a benefit or payment.
When a provider bills you for the difference between their charge and the allowed amount.
The health care services, items, and medications covered under a health insurance plan.
A plan that meets all requirements of QHPs but doesn't cover benefits other than 3 primary care visits per year before deductible.
A request for payment that you or your health care provider submits to your health insurer.
The federal agency that runs Medicare, Medicaid, and CHIP programs.
A federal law that may allow you to temporarily keep health coverage after employment ends.
Your share of costs calculated as a percentage of the allowed amount.
A fixed amount you pay for a covered health care service.
Your share of costs for services that a plan covers.
A discount that lowers deductibles, coinsurance, and copayments.
The amount you must pay for covered health care services before your plan starts to pay.
A person covered by a primary member's health insurance plan.
A list of prescription drugs covered by a health plan.
Equipment and supplies ordered by a health care provider for everyday or extended use.
An illness, injury, or symptom so serious that a reasonable person would seek immediate care.
A set of 10 categories of services that health insurance plans must cover under the ACA.
A statement from your health insurance company listing services received and costs.
A managed care plan where services are covered only if you use in-network providers.
An arrangement to set aside pre-tax money for medical expenses.
A plan created before March 23, 2010, exempted from many ACA changes.
A complaint communicated to your health insurer or plan.
A service helping people shop for and enroll in affordable health insurance.
A plan that usually limits coverage to care from contracted providers.
An employer-funded plan for tax-free reimbursement of medical expenses.
A tax-advantaged savings account for qualified medical expenses.
A plan with higher deductible than traditional insurance.
Federal law requiring national standards to protect patient health information.
A plan allowing you to direct your own health care and visit almost any provider.
Providers who have a contract with your health plan.
Insurance program providing free or low-cost health coverage to low-income individuals.
Federal health insurance program for people 65 or older and certain disabled individuals.
Health care services needed to diagnose or treat an illness that meet accepted medical standards.
The facilities, providers, and suppliers contracted with your health insurer.
Yearly period when people can enroll in a health insurance plan.
Providers who do not have a contract with your health plan.
The most you have to pay for covered services in a plan year.
A plan where you pay less for in-network providers and need referrals for specialists.
A decision by your insurer that a service is medically necessary.
A health problem you had before new health coverage starts.
A plan where you pay less for in-network providers but can use out-of-network providers.
The amount you pay for your health insurance plan, usually monthly.
A tax credit to lower your monthly insurance payment.
Routine health care including screenings, check-ups, and patient counseling.
A physician who provides the first point of contact for health concerns.
A written order from your primary care physician to see a specialist.
A plan where an employer provides health benefits directly to employees.
A time outside Open Enrollment when you can sign up after certain life events.
A type of prior authorization requiring you to try less expensive drugs first.
An easy-to-read summary for comparing health plans.
Care for conditions requiring immediate attention but not emergency room care.
A technique used by insurance companies to determine if a service is medically necessary.