| Types of Insurance Plans: May Vary By Insurance Carrier |
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PPO - Preferred Provider Organization - Allows the member to obtain
services from doctors and hospitals both in and out of the insurance
carriers network. PPO's do not require referrals form one doctor to see
another. They normally carry a richer premium due to the flexibility the
member is offered.
services from doctors and hospitals both in and out of the insurance
carriers network. PPO's do not require referrals form one doctor to see
another. They normally carry a richer premium due to the flexibility the
member is offered.
POS - Point of Service - Allows the member to obtain services from
doctors and hospitals both in and out of the insurance carriers network.
POS's do require referrals form one doctor to see another.
doctors and hospitals both in and out of the insurance carriers network.
POS's do require referrals form one doctor to see another.
EPO - Exclusive Provider Organization - Allows the member to obtain
services from doctors and hospitals in the insurance carriers network
only. Members do not need to seek the referral form their primary
physician to see a specialist.
services from doctors and hospitals in the insurance carriers network
only. Members do not need to seek the referral form their primary
physician to see a specialist.
HSA - Health Savings Account - This type of plan is offered in most of
the types of insurance plans listed above. The premise of this type of plan
is to have the member share in some of the cost for their health benefits
through higher deductibles in order to reduce the monthly premium for
coverage. The plan allows for the member to set aside funds with pretax
dollars to pay for the out of pocket expenses.
the types of insurance plans listed above. The premise of this type of plan
is to have the member share in some of the cost for their health benefits
through higher deductibles in order to reduce the monthly premium for
coverage. The plan allows for the member to set aside funds with pretax
dollars to pay for the out of pocket expenses.
HRA - Health Reimbursement Account - This type of plan is offered
for all the types of insurance plans listed above. The premise of this type
of plan is to have the member share in some of the cost for their health
benefits through higher deductibles in order to reduce the monthly
premium for coverage. This is used when the employer pays the majority
of the health insurance coverage for the employee's & their dependents.
for all the types of insurance plans listed above. The premise of this type
of plan is to have the member share in some of the cost for their health
benefits through higher deductibles in order to reduce the monthly
premium for coverage. This is used when the employer pays the majority
of the health insurance coverage for the employee's & their dependents.
Catastrophic Plan- This type of plan is available to offer the member
limited coverage in the event of an emergency. This plan offers limited
doctor and hospital visits as well as maximum annual and lifetime benefit
limits.
limited coverage in the event of an emergency. This plan offers limited
doctor and hospital visits as well as maximum annual and lifetime benefit
limits.
| Common Terms |
HMO - Health Maintenance Organization - Allows the member to
obtain services from doctors and hospitals in the insurance carriers
network only. Members need to seek the referral form their primary
physician to see a specialist.
Healthy New York applies to the HMO standard.
obtain services from doctors and hospitals in the insurance carriers
network only. Members need to seek the referral form their primary
physician to see a specialist.
Healthy New York applies to the HMO standard.
HDHP - High Deductible Health Plan / Cost Share Plan - This type of
plan is offered in all the types of insurance plans listed above. The
premise of this type of plan is to have the member share in some of the
cost for their health benefits through higher deductibles in order to reduce
the monthly premium for coverage.
plan is offered in all the types of insurance plans listed above. The
premise of this type of plan is to have the member share in some of the
cost for their health benefits through higher deductibles in order to reduce
the monthly premium for coverage.
Claim
COBRA
Co-insurance
Co-pay
Deductible
DHMO
DME
Durable Medical Equipment
Formulary Drugs
Gatekeeper
Generic Drugs
HIPPA
Home Health Care
In Patient
Maximum Out of Pocket
Non Gatekeeper
Open Access Plan - O/A
Out of Pocket
Out Patient
Pre certification
Preexisting Condition
Primary Care Physician
PCP
Referral
Timothy's Law
Usual, Customary, Rates
UCR
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