#1
What does the term 'deductible' refer to in health insurance?
The amount you pay out of pocket for covered services before your insurance starts to pay.
ExplanationInitial out-of-pocket amount before insurance coverage kicks in.
#2
What does 'co-payment' mean in health insurance?
A fixed amount (for example, $15) you pay for a covered health care service.
ExplanationFixed fee paid for each covered service.
#3
What does 'open enrollment' mean in health insurance?
The period during which individuals can change their existing health insurance coverage.
ExplanationPeriod for altering insurance coverage.
#4
What is 'Medicare' in the context of health insurance in the United States?
A federal program that provides health coverage if you are 65+ or under 65 and have a disability.
ExplanationFederal health coverage for seniors and certain disabled individuals.
#5
What is 'Medicaid' in the context of health insurance in the United States?
A state-specific program that provides health coverage to low-income individuals and families.
ExplanationState program providing health coverage for low-income individuals.
#6
What does 'coinsurance' mean in health insurance?
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
ExplanationPercentage of covered service costs paid after deductible.
#7
What is a 'pre-existing condition' in health insurance terminology?
A condition that existed before the individual's health insurance coverage became effective.
ExplanationCondition predating insurance coverage.
#8
What is a 'network' in health insurance?
The group of healthcare providers, hospitals, and facilities that have contracts with a health insurance company.
ExplanationGroup of contracted healthcare providers.
#9
What is 'prior authorization' in health insurance?
The process of approving a medical treatment or service before it is provided.
ExplanationApproval process for medical treatments.
#10
What is 'explanation of benefits' (EOB) in health insurance?
A document sent by the insurance company explaining what medical treatments or services were paid for on your behalf.
ExplanationSummary of covered medical expenses.
#11
What is 'out-of-pocket maximum' in health insurance?
The maximum limit on the amount of money you have to pay for covered services in a policy period.
ExplanationMaximum amount paid for covered services within a period.
#12
What does 'catastrophic coverage' mean in health insurance?
A type of health insurance plan that provides coverage for major medical expenses beyond a certain limit.
ExplanationCoverage for significant medical expenses after a threshold.
#13
What does 'HIPAA' stand for in health insurance?
Health Insurance Portability and Authorization Act
ExplanationRegulatory act ensuring privacy and security of healthcare information.
#14
What is 'lifetime maximum' in health insurance?
The total amount of money your insurance will pay over the course of your lifetime.
ExplanationMaximum sum covered by insurance throughout life.
#15
What is 'essential health benefits' (EHB) in health insurance?
The specific health care benefits that must be covered by individual and small group plans.
ExplanationMandatory healthcare benefits for certain plans.