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Definitions (36)
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actuary
A mathematician working for a health insurance company responsible for determining what premiums the company needs to charge based in large part on claims paid verses amounts of premium generated. Their job is to make sure a block of business is priced to be profitable.
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agent
Licensed salespersons that represent one or more health insurance companies and presents their products to consumers.BBenefit: Amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss.
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brand-name drug
Prescription drugs marketed with a specific brand name by the company that manufactures it, usually the company which develops and patents it. When patents run out, generic versions of many popular drugs are marketed at lower cost by other companies. Check your insurance plan to see if coverage differs between name-brand and their generic twins.
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broker
Licensed insurance salesperson who obtains quotes and plan from multiple sources information for clients. CCapitation: Capitation represents a set dollar limit that you or your employer pay to a health maintenance organization (HMO), regardless of how much you use (or don't use) the services offered by the health maintenance providers. (“Provi [..]
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carrier
The insurance company or HMO offering a health plan.
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case management
Case management is a system embraced by employers and insurance companies to ensure that individuals receive appropriate, reasonable health care services.
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certificate of insurance
The printed description of the benefits and coverage provisions forming the contract between the carrier and the customer. Discloses what it covered, what is not, and dollar limits.
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claim
A request by an individual (or his or her provider) to an individual's insurance company for the insurance company to pay for services obtained from a health care professional.
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cobra
Federal legislation that lets you, if you work for an insured employer group of 20 or more employees, continue to purchase health insurance for up to 18 months if you lose your job or your coverage is otherwise terminated. For more information, visit the Department of Labor.
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co-insurance
Co-insurance refers to money that an individual is required to pay for services, after a deductible has been paid. In some health care plans, co-insurance is called "co-payment." Co-insurance is often specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the employer or insurance company [..]
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