Glossary of Health Care Terms
A-H · I-P · Q-ZAppeal - The process of requesting a provider or health plan pay for a service for which payment has been denied.
Auto-Enrollment - The automatic assignment of a person to a health insurance plan.
Broker - A salesperson that has obtained a state license to sell and service health plan and insurer contracts.
Claim - A request by an individual that his or her insurance company pay for medical services received.
COBRA - Federally supported health care benefits for people whose employment has been terminated, or who have experienced other circumstances that lead to loss of coverage.
Copayment - The set amount of money a health plan enrollee pays for a specific service.
Deductible - The minimum amount of out-of-pocket expenses a health care plan enrollee must pay for medical services or medication before their plan begins to cover expenses.
Employee Assistance Program (EAP) - Benefits that are designed for personal or family problems, including mental health, substance abuse and other problems.
Enrollee - A subscriber or dependent that is eligible for coverage under a certain health care contract.
Exclusions - Conditions or situations not covered under a certain contract or plan.
Fee-For-Service (FFS) - A traditional method of payment for health care services where users pay for services rendered.
Flexible Spending Account (FSA) - A plan that provides employees with the opportunity to set aside funds pre-tax for certain medical expenses.
Group Health Plan - Health coverage to employees and their families, provided by an employer or employee organization.
Health Maintenance Organization (HMO) - A type of U.S. health care coverage where subscribers are required to receive all of their health care from a provider within a given network.
Health and Human Services (HHS) - The U.S. department that is responsible for health-related programs and issues.
Health Care Provider - Providers of medical or health care.
Individual Plans - A type of insurance plan for individuals and families not eligible for health care coverage through an employer.
Lifetime Limit - A cap on the benefits available during a subscriber's lifetime under a given policy.
Managed Care - Systems and techniques used to manage health care services.
Medicaid - A federal and state program that helps with medical costs for some low-income individuals and families.
Medicare - A federal program that helps cover the medical costs of elderly and disabled individuals.
Open Enrollment Period - A period during which subscribers in a health program can revise their benefits.
Patient Assistance Programs - Programs offered by pharmaceutical companies to provide free or low-cost medications to people who could not otherwise afford them.
Pre-Existing Condition - A condition or illness that you have before enrolling in a health care plan.
Preferred Provider Organization (PPO) - A type of health care plan where a group of doctors and hospitals agrees to render particular services to a group of people for a reduced cost. This type of insurance is generally more expensive than HMOs but offers subscribers more freedom to select physicians.
Premium - The amount paid to a health care company for providing medical coverage under a contract.
Preventive Care - Health care that emphasizes prevention, early detection and early treatment.
Primary Care Physician (PCP) - A "generalist" physician who, under certain health care plans, is accountable for the total health services of enrollees.
Referral - The process of referring a patient to another doctor for specific health care services.
State Health Insurance Assistance Program (SHIP) - A state-run, federally funded program that provides free local health insurance counseling to Medicare subscribers.
Waiting Period - The minimum amount of time an individual must wait before becoming eligible for specific benefits after coverage has begun.
Workers' Compensation - Insurance that covers employees who get sick or injured on the job.