VOCABULARY: Health Insurance

Out of Pocket Maximum

• The maximum amount you can spend on health insurance premiums in a year.

• The total amount you pay for health care services before your insurance kicks in.

• After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

• The amount you pay for each visit to a healthcare provider.

POS

• Point of Service: A combined type of plan where a patient can stay in the network (PPO) or can go out of network if they choose.

• Preferred Provider Organization: A type of health insurance plan that offers a network of healthcare providers.

• Health Maintenance Organization: A type of health insurance plan that requires members to choose a primary care physician.

• Exclusive Provider Organization: A type of plan that only covers services provided by in-network providers.

Medicare

• A federal health insurance program for people who are 65 or older or for certain younger people with disabilities.

• A private insurance plan for individuals under 65 years old.

• A government program that provides free healthcare to all citizens.

• A health insurance program specifically for veterans.

Deductible

• The amount you pay before your plan starts to pay.

• The total cost of your insurance premium.

• The percentage of costs you pay after your deductible is met.

• The maximum amount you will pay out of pocket in a year.

Flexible Spending Account (FSA)

• An account that can be used to pay for qualified expenses, tax-free.

• A savings account that earns interest on deposits.

• A type of investment account for retirement savings.

• An account that can only be used for medical expenses.

EPO

• Exclusive Provider Organization: A health insurance plan that only covers doctors within your network, but gives you freedom to go straight to a specialist when you need it.

• Exclusive Provider Organization: A health insurance plan that covers any doctor regardless of network.

• Exclusive Provider Organization: A type of insurance that requires referrals to see specialists.

• Exclusive Provider Organization: A health insurance plan that only covers emergency services.

Open Enrollment Period

• A time frame where the consumer can change their health plan, usually arranged by the employer.

• A period when health plans are not available for enrollment.

• A time when consumers can only enroll in government-sponsored health plans.

• A phase where consumers can only change their health plan once a year.

What does PPO stand for?

• Preferred Provider Organization

• Personal Provider Option

• Primary Physician Organization

• Patient Protection Option

Premium

• The amount of monthly payment to receive the insurance benefit

• A type of insurance policy

• The total coverage amount of an insurance plan

• The deductible amount for insurance claims

HMO

• Health Maintenance Organization

• Health Management Organization

• Health Medical Organization

• Health Monitoring Organization