Health insurence

Primary Care Provider

- A health care professional (usually a physician) who is responsible for monitoring an individual's overall health care needs. Typically, a PCP serves as a "quarterback" for an individual's medical care, referring the individual to more specialized physicians for specialist care.

Mandated Employer Insurance

- requires employers with 50 or more employees to provide health coverage to those employees and sets a minimum baseline of coverage and employer contributions. Employers who do not comply will face annual penalties based on the number of employees in the firm.

Co-payment

A payment made by an individual who has health insurance, usually at the time a service is received, to offset some of the cost of care. These payments are a common feature of HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) health plans in the US. The payment size may vary depending on the service, generally with low payments required for visits to a regular medical provider and higher payments for services received in the emergency room, the latter intended to discourage insured persons from using the emergency room unless it is absolutely necessary. Also called co-insurance.

Health Savings Account

An account that allows individuals to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax free basis.

Preventative Care

An approach to health care which emphasizes preventive measures and health screenings such as routine physicals, well-baby care, immunizations, diagnostic lab and x-ray tests, pap smears, mammograms and other early detection testing. The purpose of offering coverage for preventive care is to diagnose a problem early, when it is less costly to treat, rather than late in the stage of a disease when it is much more expensive, or too late to treat.

Third-party Payer

Any payer of health care services other than the insured person. This can be an insurance company, HMO, PPO, or the federal government.

Managed care

Any system that manages healthcare delivery with the aim of controlling costs. Managed care systems typically rely on a primary care physician who acts as a gatekeeper through whom the patient has to go to obtain other health services such as specialty medical care, surgery, or physical therapy.

Employer sponsored health insurance (coverage)

Of Americans who have health coverage, nearly 60 percent secure that coverage through an employer-sponsored plan, often called group health insurance. Millions take advantage of the coverage for reasons as obvious as employer responsibility for a significant portion of the health care expenses. Group health plans are also guaranteed issue, meaning that a carrier must cover all applicants whose employment qualifies them for coverage. In addition, employer-sponsored plans typically are able to include a range of plan options from HMO and PPO plan to additional coverage such as dental, life, short- and long-term disability.

Cost-sharing

This occurs when the users of a health care plan share in the cost of medical care. Deductibles, coinsurance, and co-payments are examples of cost sharing.

Universal health care

a government sponsored health program that provides all eligible citizens with a basic form of health insurance including dental and vision. This type of plan is also called a 'single-payer' plan which means that one entity-the government-would be in charge of paying health care costs and collecting heath care fees

Health Maintenance Organization (HMO)

a kind of managed care health insurance plan. HMO's are companies that have contracts with doctors and other health care providers and they are directly involved in the medical treatment of their customers. While HMO health insurance plans are generally the cheapest kind of coverage available, they are also the most restrictive. These usually have a deductible but no coinsurance requirement.

Medicaid

a state-administered health insurance program for low-individuals that is jointly funded by the federal and state governments. Accounting for over 40 percent of all federal funds flowing to the states, the program has become the largest single federal financing source for states.

Fee-for-Service Plan

a system of health insurance payment in which a doctor or other health care provider is paid a fee for each particular service rendered..

Private health insurance

insurance plans marketed by the private health insurance industry - currently dominates the U.S. health care landscape, with approximately two-thirds of the non-elderly population covered by private health insurance. Coverage includes policies obtained through employer-sponsored insurance, with approximately 62 percent of non-elderly Americans receiving insurance provided as a benefit of employment. Another 5 percent of the non-elderly group bought coverage outside of the workplace on the individual health insurance market.

Single-payer System

is a health care system in which one entity - a single payer - collects all health care fees and pays for all health care costs. Proponents of a single-payer system argue that because there are fewer entities involved in the health care system, the system can avoid an enormous amount of administrative waste. Instead, all health care providers in a single-payer system would bill one entity for their services. Within a single-payer system, all citizens would receive high-quality, comprehensive medical care PLUS the freedom to choose providers. Paperwork would be dramatically reduced with the elimination of bills, co-pays and deductibles.

Preferred Provider Organization (PPO)

is a managed care organization of health providers who contract with an insurer or third-party administrator (TPA) to provide health insurance coverage to policy holders represented by the insurer or TPA. Policy holders receive substantial discounts from health care providers who are partnered with the PPO. If policy holders use a physician outside the PPO plan, they typically pay more for the medical care.

Subsidized Health Insurance

is an insurance plan with reduced premiums. The premiums are reduced because of the involvement of an outside entity that is paying, or subsidizing, the premium payment. There are many sources for subsidized health insurance.

Private Care

is when doctors, dentists, and other healthcare providers are paid for through private insurance and (occasionally) out of private bank accounts. This is in contrast with a public system, in which they are paid by the government.

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, referred to as a "copayment." 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 pays 80 percent.

Underinsured

refers to various degrees of being insured for some real risks and uninsured for others, at the same time.

COBRA

the Consolidated Omnibus Budget Reconciliation Act of 1985, federal legislation that allows you - if you work for an insured employer group of 20 or more employees - to continue to purchase health insurance for up to 18 months if you lose your job, or your employer-sponsored coverage is otherwise terminated.

Deductible

the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts.

Premium

the amount you or your employer pays in exchange for health insurance coverage

Medicare

the federal health insurance program for 47 million elderly and disabled Americans. In 2010, spending on this insurance program accounted for 12% of the federal budget. Accounts for 23% of total national health care spending.