Admitting Privileges: Privileges given to a doctor to admit patients to a specific hospital.
Brand-name drug: Prescription drugs may be available as a brand name or generic. The brand name is usually marketed by the company that developed and patented it. There may be a cost difference by your insurance company between using brand name and generic drugs.
Broker: An insurance broker is licensed and has the ability to obtain insurance quotes and insurance plans for clients.
Certificate of Insurance: A document that certifies an insurance policy has been obtained and an overview of what the policy covers, but it is not the actual insurance policy.
Claim: A request for payment, as per the terms of the policy.
Co-Insurance: The amount that an individual is required to pay for their policy deductible has been paid. Co-insurance is often specified in the policy by a percentage, i.e., the individual pays 30% toward the cost of services and the insurance company pays 70%.
COBRA: Insurance that gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances For more information, visit the Department of Labor.
Deductible: An amount, designated by an insurance policy, that must be paid by the insured for health care expenses before the insurance covers the costs.
Effective Date: The date your insurance policy begins.
Exclusions: Services that are not covered by an insurance policy.
Generic Drug: The FDA defines generic drug as “a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use.” Generic drugs may be less expensive than brand name drugs.
Group Insurance: Health care coverage offered to employees, members of an association or other recognized group that may offer more services at a lower cost per participant.
Health Maintenance Organization (HMOs): An HMO is a health plan that offers many kinds of health care services to its members. In return, members (and their employers) pay a fixed cost each month for these services. HMO’s usually do not have a deductible and offer lower monthly payments and co-payments.
HIPAA: The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.
Long-Term Care Policy: Long term care insurance is used to augment insurance to cover the costs of care not covered by traditional insurance. Covered services often include skilled nursing facilities, home care, assisted living, adult day care and custodial care.
Long-Term Disability Insurance: Insurance that covers a percentage of the insured’s monthly earnings in the event of an illness or injury that prevents working.
LOS: An acronym that refers to length of stay.