Glossary of Health Insurance Terms | Blue Cross and Blue Shield of Illinois

October 30, 2022

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Health Insurance: Understanding What It Covers – familydoctor.org

a

affordable care law

A comprehensive law passed in 2010, the Affordable Care Act aimed to reform America’s health care system to improve access and affordability for more Americans.

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charge allowed

the maximum amount a health plan will reimburse a doctor or hospital for a given service.

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annual deductible

the amount you must pay annually before reimbursement from your health plan begins.

Deductible requirement does not apply to preventive services.

annual limit

An insurance plan may limit the dollar amount it will pay in a year for a certain treatment or service, or for all benefits provided in a year.

b

benefits

Health care items or services covered by a health plan. Your health plan may sometimes be called a “benefit package.”

c

catastrophic plan

The health insurance exchange will include a catastrophic plan option. Catastrophic plans have lower premiums, but start paying only after you’ve first paid a certain amount for covered services, or simply cover more expensive levels of care, like hospital stays. catastrophic plans are an option to consider for young adults and people for whom coverage would otherwise be inaccessible.

claim form

a form that you or your doctor complete and submit to your health plan for payment.

claim

an itemized bill from a health care provider, for health services provided to a member.

cobra

This stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. This federal law requires group health plans to allow covered employees and dependents to continue their group coverage for a set period of time after a qualifying event that causes loss of group health coverage . qualifying events include reduced work hours, termination of employment, a child becoming an adult dependent, Medicare eligibility, death or divorce of a covered employee, among others.

coinsurance

The percentage of the cost of a covered health care service or prescription drug that you pay after you pay your deductible. you pay 100 percent of the total allowed amount until you meet your deductible.

consumer directed health plan (cdhp)

a health plan with a health savings account (HSA) or other tax-advantaged account. Consumer-driven health plans give members more control over health care spending because the deductible is higher and care is paid for with the health savings account.

contracted hospital

a hospital that has a contract with a particular health plan to provide hospital services to members of that plan.

coordination of benefits

When you need care and are in two different health plans, your insurers will coordinate your benefits to give you the most coverage when you need it. helps prevent duplicate payments and ensures each plan makes the correct payments.

copayment

The fixed dollar amount you pay for a covered health care service at the time you receive care or when you fill a prescription.

cost share reduction (csr)

a discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copays. You can get this discount if your income is below a certain level and you choose a health plan in the silver plan category. If you are a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.

covered person

the eligible person enrolled in the health plan and any enrolled eligible family members.

covered service

a service that is covered under the terms of your health plan.

d

deductible

the amount you pay for most covered services before your health plan begins to pay. When you see a provider that is in the plan’s network, before you meet your deductible, you may pay a discounted amount that has been negotiated with the provider. the deductible resets at the beginning of the calendar year or when you enroll in a new plan.