Health Insurance Glossary

This is a list of health insurance related terms and definitions. Test your knowledge with a game of health insurance glossary hangman. If you think it's missing any important terminology, please let me know. Thanks for your visit. Enjoy!

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Health Insurance Terms Hangman

Terms Continued

Lapse
Termination of insurance for non-payment of premium.
Lifetime Maximum
A cap on the benefits paid for the duration of a health insurance policy. Many policies have a lifetime limit of $5 million, which means that the insurer agrees to cover up to $5 million in covered services over the life of the policy. Once the $5 million maximum is reached, no additional benefits are payable.
Limited Policy
A policy that covers only specified accidents or sicknesses (e.g. a cancer policy).
Major Medical
Health insurance coverage for expenses associated with hospital confinements, surgeries and/or medical conditions requiring a broad range of medical services and supplies.
Managed Care
An organized way to manage costs, use, and quality of the health care system. The major types of managed care plans are health maintenance organizations and preferred provider organizations.
Master Policy
The group insurance policy that explains coverage to all members of the group.
Medicaid
Federal and state health insurance program for low-income individuals who meet established eligibility criteria (programs vary from state to state).
Medical Necessity
Medical information justifying that the service rendered or item provided is reasonable and appropriate for the diagnosis or treatment of a medical condition or illness.
Medicare
Federal health insurance program for the elderly age 65 and older, certain disabled individuals, and those with end-stage renal disease. Medicare is administered by the Center for Medicare and Medicaid Services, formerly the Health Care Financing Administration.
Medicare Supplement
A supplemental insurance policy to help cover the difference between approved medical charges and benefits paid by Medicare. These plans are also known as Medi-gap plans.
Medical Savings Account
A tax-advantaged personal savings account used in conjunction with a high deductible health policy. Individuals can contribute money to this account on a pre-tax basis to set aside money for qualified medical care and expenses, including annual deductibles and co-payments.
MSA
An acronym for Medical Savings Account.
Medically Necessary
Many insurance policies will pay only for treatment that is deemed medically necessary to restore a person to health. For instance, many health insurance policies will not cover routine physical exams or plastic surgery for cosmetic purposes.
Medigap
A supplemental insurance policy to help cover the difference between approved medical charges and benefits paid by Medicare. These plans are also known as Medicare Supplement plans.
Misrepresentation
Lying or misleading an insurance company about the facts affecting a policy. Misrepresentation is grounds for voiding a policy.
Morbidity
A mathematical representation of the occurrence of illnesses to a specific classification of people.
National Association of Insurance Commissioners
A national organization of state officials charged with regulating insurance. NAIC was formed to promote national uniformity in insurance regulations.
NAIC
An acronym for National Association of Insurance Commissioners.
National Committee for Quality Assurance
A national group responsible for devising and monitoring quality measurements and standards for health care entities.
NCQA
An acronym for National Committee for Quality Assurance.
National Drug Code
Numerical coding system for drug identification. NDC numbers are assigned by the Food and Drug Administration and are typically used to bill payers for the drugs provided to health care beneficiaries.
NDC
An acronym for National Drug Code.
Network
Groups of physicians, hospitals and other health care providers working with the health plan to offer care at negotiated rates.
Network Provider
Physicians, hospitals or other providers of medical services that have agreed to participate in a network, to offer their services at negotiated rates, and to meet other negotiated contractual provisions. Also called participating provider.
Noncancellable Policy
A policy that guarantees you can receive insurance, as long as you pay the premium.  It is also called a guaranteed renewable policy.
Nonrenewable
An insurance policy that cannot be renewed or continued after its expiration date.
Open Enrollment
A period each year during which employees have an opportunity to change their employer-provided health care coverage. They usually can choose among various plans from different health insurance providers.
Out-Of-Network
Health care services received outside the HMO or PPO network.
Out-Of-Plan
This phrase usually refers to physicians, hospitals or other health care providers who are considered non-participants in an insurance plan (usually an HMO or PPO). Depending on an individual's health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered at a reduced benefit level.
Out-of-Pocket Costs
Insured health care costs for which one is responsible, because of the application of deductibles, coinsurance and co-payments.
Out-of-pocket maximum
Total dollar amount an insured will be required to pay for covered medical services during a specified period, such as one year. The out-of-pocket maximum may also be called the stop-loss limit or catastrophic expense limit.

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