Glossary
All
| Term | Definition |
|---|---|
| Allowed Amount |
The amount of the billed charge the insurance company deems is payable by the plan. This may or may not equal the amount actually billed by the provider. The insurance carrier may limit the amount it will consider for payment based upon Usual, Customary, and Reasonable or because of a negotiated fee with the provider. |
| Ambulatory Care |
Medical care on an Outpatient basis, such as hospital outpatient clinics and ER Departments, physician's office and home health care are examples. |
| Ancillary Services |
The name given to professional services such as laboratory tests and radiology exams. |
| Co-Insurance |
The co-insurance clause requires you to pay a percentage (or a fixed dollar amount) of your covered medical expenses. This means that after you have paid the deductible amount (if any) as stated in your policy, you will pay the stated percentage of the medical bills, and the insurance company will pay the remaining amount of the covered medical expenses. When your total expenses reach a dollar amount stated in your policy (see Out-of-Pocket Maximum), the insurance company pays 100% of the covered expenses up to the maximum benefit of your policy. |
| Emergency |
Generally means the onset of a medical condition that manifests itself by symptoms of sufficient severity that a prudent person would believe that the absence of immediate medical attention could result in serious jeopardy to the health of the person, serious impairment of a bodily function or serious dysfunction of any bodily organ or part. |
| HSA |
Health Savings Account |