Health Insurance Vocabulary - Common Terms related to Health Insurance
This article presents and explains terms which are related to Health Insurance Services - Common Terminology related to Insurance Services in Health.
This article gives the description and meanings of the various terminologies related to Insurance services in the health sector which are many a times difficult to understand to the common people and often a refraining factor for the people to take up the advantages of Health Insurance.Health Insurance Vocabulary - Dictionary of words in Insurance related to Health
1. Actuary
An Actuary is a person who is a mathematician for a Insurance company in the Health division (Health insurance company). The Actuary is responsible for calculating and determining the premiums a company needs to charge which is based largely on the amount of claims paid as compared to the amount of premium generated and make sure that a business is priced accordingly to make profits for the company.
2. Admitting Priviledges
Admitting Priviledges mean the rights given to a Doctor to choose whether or not to admit a patient to any particular hospital.
3. Advocacy
Advocacy means an activity or work or deed done to help a person or a group of persons to get what they want.
4. Agent
Agents are salepersons who are licensed by the Health Insurance companies and are trained to present their health insurance products and services to the people (also known as consumers).
5. Association
An association necessarily means a group who can offer individualized health insurance plans which are created and designed for their members.
6. Benefit
The amount which a person would be receiving who has registered for a Health insurance policy with a health insurance company after he suffers from a loss is known as benefit of the person who is better known as Claimant or assignee or beneficiary in the case.
7. Brand-name drug
Medicines are produced by various Pharmaceutical companies and they are marketed under various names as designated by the Pharmaceutical Company. Some medicines are prepared under patents by the first company and when the patents are over and expired, then the other Pharmaceutical companies produce it at lower costs and are marketed as Generic drugs. One should check whether their Health Insurance policy covers only Generic Drugs or also Branded Drugs too or both.
8. Broker
A broker in a Health Insurance Company is a Salesperson who is licensed by the health insurance company who obtains information about a Health insurance policy and gives quotes and plans the insurance policy for his clients.
9. Capitation
Capitation means the limit in dollars which is set by the person paying the insurance or the employer paying the insurance to a Health Maintenance Organisation (HMO) regardless of how much the services of the Health Maintenance Organisation are used.
10. Carrier
Carrier is the particular Health Insurance Company or the Health Maintaining Organization (HMO) who is offering the Health Insurance Policy Plan.
11. Case Management
Case Management is the system and methodology which is adopted by the Employers and the Health Insurance Companies in a way to make sure that their clients and individuals receive appropriate and proper Health Care Services as mentioned by them in their Policy.
12. Certificate of Insurance
Certificate of Insurance is the printed copy of the description of benefits and coverage facilities and provisions which form the contract between the carrier (Health Insurance Policy giving company) and the customer who has bought the particular Health Insurance Policy. This Certificate also tells about what the policy is going to cover and what other health related and other issues it is not going to cover and also the Dollar or currency limits for Coverage.
13. Claim
Claim is a request made either by an individual or by the provider of the individual to the Health Insurance Company providing the Health Insurance Policy to pay for services thus obtained from a registered health care professional and other related issues under the coverage of the Health Insurance Policy.
14. Co-Insurance, Co-Payment and Deductibles
The above mentioned terms define a certain amount which a individual has to pay for his health services after the Health Insurance Company has paid the rest of the amount.
Co-Payment is that Co-Insurance which is pre-determined and regardless the reason of visit and the charges required for the visit the individual having a Health Insurance Policy has to pay a fixed amount per visit.
15. Credit for Prior Coverage
Thid term defines a pre existing condition waiting period which is incident when an employer's coverage can be enhanced or qualified by your plan and if any interruption in the two plans meets the laid down state guidelines.