Glossary of Ohio Health Insurance Terms

Here are some relevant terms covered in this Ohio health insurance guide:

• Approved Amount - The dollar amount on which an insurance company bases its payments and your copayments. This may be less than the billed charge.
• Beneficiary - A person who receives the benefits of any insurance plan or policy.
• Benefit Maximum - The most a health insurance policy will pay for a specified loss or covered service. The beneit can be expressed as either a period of time, a dollar amount or a percentage of the approved amount. Benefits may be paid to the policyholder or a third party.
• Benefit Period - The time for which beneit payments from an insurance policy are available. A policy may include different beneit periods for different kinds of treatment or services.
• Billed Charge - The dollar amount a health care provider bills to a patient for a particular medical service or procedure.
• Certiicate Holder - An employee or other insured named under a group health insurance policy.
• Chronic Condition - A continuous or prolonged illness or condition. Examples: asthma, diabetes, varicose veins.
• Claim - A request for payment for services.
• COBRA (Consolidated Omnibus Budget Reconciliation Act) - Federal law requiring that workers who end employment for specified reasons have the option of continuing group insurance through the employer for a limited period of coverage (usually 18 months; can be 29 months or 36 months).
• Conditionally Renewable - An insurance policy that the company will renew with each premium payment, as long as you meet certain conditions. Coordination of Benefits (COB) - Procedures used by insurers to avoid duplicate payments when a person is covered by more than one policy.
• Copayment (coinsurance) - A specified dollar amount or percentage of covered expenses which an insurance policy or Medicare requires a beneiciary to pay toward eligible medical bills. Covered Services - Services for which an insurance policy will pay.
• Deductible - A specified dollar amount of covered medical expenses which the beneiciary must pay before an insurance policy will pay.
• Enrollment Period - Period during which people can enroll for an insurance policy, Medicare or Health Insuring Corporation / Health Maintenance Organization (HMO) benefits.
• Exclusion - A procedure or condition which an insurance policy does not cover.
• Experimental - Medical treatment which is not generally accepted within the medical profession. Insurance policies sometimes do not cover these procedures. Companies often disagree with doctors on whether a speciic procedure or treatment is experimental.
• Explanation of Benefits (EOB) - A statement from an insurance company showing which payments have been made on a claim.
• Federally Eligible Individual (FEI) - A person who meets federal standards for continuing or obtaining health care coverage under HIPAA.
• Fee For Service - Traditional insurance that does not place restrictions on which doctors you can use. The insurer pays a percentage of the expense you incur.
• Free Look - The period during which you may reconsider the purchase of an insurance policy, cancel and get a full refund. Individual health policies have a free look of at least 10 days; Medicare supplement and long-term care policies have 30-day free look periods