Claim:
A request for payment for benefits received or services rendered.
Coinsurance:
Coinsurance is a form of cost-sharing in which the member must pay a specified percentage of all remaining eligible medical expenses after the deductible has been paid.
Important Information: Please be aware that some services and supplies received by members in an office setting or in connection with an office visit are in fact provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. Prior to scheduling an appointment, please confirm with your provider whether the practice is hospital-owned or whether any services are hospital-based and may be subject to deductible and coinsurance.
Contributions:
Money you (or someone else) deposits into your health savings account (HSA). Contributions are tax-deductible, and are subject to annual limitations outlined by the IRS and based on your health plan deductible.
Co-payment (or copay):
The fixed-dollar amount which is due and payable by the member at the time a covered service is provided.
Important Information: Please be aware that some services and supplies received by members in an office setting or in connection with an office visit are in fact provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. Prior to scheduling an appointment, please confirm with your provider whether the practice is hospital-owned or whether any services are hospital-based and may be subject to deductible and coinsurance.
Deductible:
The amount of loss or expense for covered services that must be incurred by an insured before an insurer will assume any liability for all or part of the remaining cost of covered services.
Important Information: Please be aware that some services and supplies received by members in an office setting or in connection with an office visit are in fact provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. Prior to scheduling an appointment, please confirm with your provider whether the practice is hospital-owned or whether any services are hospital-based and may be subject to deductible and coinsurance.
Distribution:
Money you withdraw from your health savings accout (HSA). Withdrawals can be made in a variety of ways, including by using your HSA debit card or checkbook.
High Deductible Health Plan (HDHP):
A federally defined health benefit design that qualifies someone to open a health savings account (HSA). Members covered under high deductible health plans do not have benefits for any coverage (e.g., office visits, emergency room visits and prescription drugs) prior to meeting the deductible (with the exception of preventive care).
In-network:
Refers to the use of providers who participate in the health plan's provider network. Many benefit plans encourage enrollees to use participating (in-network) providers to reduce the enrollee's out-of-pocket expense
Medical Savings Account (MSA):
A tax-exempt trust or custodial account established for the purpose of paying medical expenses in conjunction with a high-deductible health care plan. The MSA is the former name for what is now called the health savings account in the United States. The provisions of the MSA were made more advantageous and available to more people in the new HSA. The changes were made in legislation signed by George W. Bush on December 8, 2003.
Out-of-network:
Services performed by a provider who has not signed a contract with the member's health plan to be part of a provider network.
Preventive care:
Medical services provided by or upon the direction of a doctor or other provider related to the prevention of disease.
Primary Care Physician (PCP):
A doctor selected by the enrollee to be the first physician contacted for any medical problem. The doctor acts as the patient's regular physician and coordinates any other care the patient needs, such as a visit to a specialist or hospitalization.
Specialists:
Providers whose practices are limited to treating a specific disease (e.g., oncologists), specific parts of the body (e.g., ear, nose and throat), or specific procedures (e.g., oral surgery).
Subscriber:
The person whose name appears on the identification card issued by the Plan and who is enrolled according to the records of the Plan. In the context of a group insurance plan, the subscriber is the individual who belongs to the group (e.g., employee); members consist of subscribers together with their covered dependents.
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