Co-insurance
the percentage of the bill for services that the policy holder must pay
co-payment (co-pay)
a specific amount paid by the patient for each medical service, such as $15.00 for each doctor visit or each prescription filled
Deductible
amount the patient must pay before the insurance starts to pay for services
group plan
the insured and, usually, their employer share the amount of the premium
Health Maintenance Organization (HMO)
insurance method that focuses on prevention of disease, must see providers from an approved list
Indemnity Plan
traditional health insurance plan with freedom to visit physician of choice
individual plan
the insured pays the total amount of the premium
Medicaid
government payment of healthcare services for people with low income, children who qualify for services and people who are disabled or blind
Medicare
government payment for healthcare for patients over 65, any person with a disability that has received social security benefits for at least 2 years, or anyone with end stage renal disease
Medigap
a private insurance policy that pays the difference between the medical charge and the amount that Medicare pays
out of pocket
medical bill that is not covered by insurance and must be paid by the patient
Preferred Provider Organization (PPO)
group of healthcare providers that provide services to a specific group, often at a reduced rate
Premium
the periodic amount paid to an insurance company for healthcare or prescription drugs
private insurance
the insured pays a monthly premium for insurance plan
reimbursement
amount paid to patient toward the cost of healthcare services
TRICARE
military health plan that provides services for active duty personnel and their families, survivors of military personnel and retired military personnel and their families
Veterans Health Administration
provides healthcare services to anyone who served in the military
Workers Compensation
health insurance plan that pays for the healthcare of workers injured on the job
cost containment
methods used to control the cost of healthcare
Diagnostic Related Groups (DRGs)
system to classify diagnoses into similar groups and is used to determine the amount of Medicare payment to a healthcare provider
for-profit agency
facility that operates for a monetary profit
government agency
agency sponsored by the government and supported by taxes
health information management systems (HIMS)
management of personal healthcare information by the healthcare agency
In-patient care
services provided to a patient within a hospital
managed care
healthcare system designed to reduce cost of healthcare
outpatient care
services that do not require the patient to stay overnight in the hospital
preventative care
the focus is to promote good health and to prevent illness
Telemedicine
healthcare services provided from a distant place