Health Insurance Terms and Definitions Pt2
However, as you have to make co-payment of $15 each time you visit the doctor, you will still have to pay this co-payment.
Maximum Benefit for Life
This is the maximum amount that the health insurance firm will pay for your medical bills during the term of your plan. Generally, this figure is millions of dollars. Except you have a very serious condition, it is likely that you will not use this value.
Preferred Provider Organization
A Preferred Provider Organization (also known as PPO) is a group of participating medical providers who have agreed to work with the health insurance company at a discounted rate. It’s a win-win situation for each side. The insurance company has to pay less and the suppliers receive automatic referrals. In most Short Term Health Insurance 2020 with https://www.healthinsurance2020.org, you will see different levels of benefits depending on whether you visit a participating or non-participating provider. A PPO plan offers more flexibility for the insured because they can visit a participating or non-participant provider. They only get a better price if they use a participant.
Health Care Organization
A health maintenance organization (also known as an HMO) is a health insurance plan that restricts you to only using specific medical providers. In general, unless you are outside the area of your network, no benefit will be paid if you go to a non-participating physician. Generally, you should select a primary care physician who will be your primary care physician (PCP). Every time you have a health problem, you should visit this doctor first. If they feel they need it, they will send it to another provider on the network. However, you cannot simply decide on your own visit a specialist; You must go through your PCP.
You will see this term on all health insurance plans and it is a frequent cause of rejected claims. Most insurance companies do not cover expenses they do not consider clinically necessary. Just because you and/or your doctor believe something is medically necessary, your health insurance company may not do so. For this purpose, you should always check that all of the expensive procedures you consider will be insured.
Generally, this refers to preventive services. For instance, an annual physical assessment which is performed regularly is generally considered a routine. Most immunizations received by adults and children are included in this classification. Some insurance companies offer limited coverage for routine treatment; others do not provide any benefit.
A pre-existing condition is a condition for which you have purchased and / or received treatment prior to the effective date of your prevailing health insurance plan. Health insurance firms differ in how they treat previously existing situations. Certain firms will not give you insurance if you have certain pre-existing chronic conditions. Others will provide coverage, but will not give you any benefit for a period of time, usually 12-24 months. However, other health insurance companies will specifically exclude a pre-existing condition from a plan and will never provide any benefit to that condition. Make sure that you are very clear about the pre-existing limitations of your plan so that you do not be surprised when you visit your doctor.