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LEARN ABOUT YOUR HEALTH!

HMO, COBRA, deductible, copaymentKnowing the special terms used by health insurance companies is important. So how do you find the definitions for such special words?  One way is to use a glossary. Often there is a glossary at the back of your health plan. A glossary is like a little dictionary of special words and terms. Check out this page from the glossary of a health plan.

Health Plan Glossary

Copayment: Depending on the kind of insurance you have, you may have to pay something each time you visit a doctor or get a prescription filled. The amount you have to pay is your copayment. Your health insurance pays the rest. For example, you might pay $15 for each prescription that you have filled, or you may have to pay $10 each time you visit the doctor.

Deductible: This is the amount you pay before your health insurance kicks in. For example, if you have a $250 deductible, you have to pay for the first $250 of medical bills out of your own pocket. After that, the insurance company helps pay your medical bills.

Generic Medicine: This medicine has the same ingredients as brand-name medicine but is usually cheaper. When you get a prescription from your doctor, ask if you can get it filled with generic medicine. If you can, make sure to tell your pharmacists that you want generic medicine.

Health Maintenance Organization (HMO): An HMO (Health Maintenance Organization) is an organization that provides one type of health insurance. The HMO has agreements with certain doctors and hospitals to give members of the HMO medical care at a reduced cost. An HMO will give you a list of doctors, and you must choose one. With some HMOs, you will pay nothing when you visit a doctor. With other HMOs, you may have to pay a copayment.

Out of Plan: Most insurance plans provide you with a list of doctors who are part of the plan. If you want to see a doctor who is not on the list, you are going “out of plan.” You may have to pay the entire cost of the visit yourself if you go “out of plan.”

Pre-existing Condition: This is an illness or a condition that you had before you joined the health plan.

Primary Care Provider (PCP): Your PCP (Primary Care Provider) is your main doctor, the one you go to first. Sometimes your PCP will refer you to a specialized doctor, such as a foot doctor or a skin doctor.

TRY THIS

  1. A copayment is:
    a. a health plan that gives you free insurance.
    b. the amount you have to pay each time you visit a doctor or get a prescription filled.
    c. the amount you pay each year for health insurance.

  2. Out of plan means:
    a. staying in the hospital overnight.
    b. your health insurance has been cancelled.
    c. seeing a doctor that is not in your health plan.


    woman at doctor's office

  3. A pre-existing condition is:
    a. a company you worked for a while ago.
    b. the person who had your job before you did.
    c. a medical condition you had before your insurance started.

  4. Your deductible is:
    a. the amount you must pay before your health insurance begins to pay out toward your medical bills.
    b. the amount a hospital charges for an overnight stay.
    c. the amount you must pay your doctor after each visit.

  5. Your primary care provider is:
    a. a doctor who is a specialist in foot care.
    b. your main doctor.
    c. your insurance company.




  6. Generic medicine:
    a. is usually more expensive than brand-name medicine.
    b. is usually cheaper than brand-name medicine.
    c. always costs the same as brand-name medicine.

  7. An HMO is:
    a. the amount you pay each time you visit the doctor.
    b. a condition that you had before.
    c. a type of health insurance.

IT'S A FACT!
About 16 PERCENT OF ALL
AMERICANS have NO health insurance.Education Development Center, Inc. © 2001.Answers: 1. b; 2. c; 3. c; 4. a; 5. b; 6. b; 7. c

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