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More Relevant Ohio Health Insurance Terms

Grace Period - A set period after an insurance policy premium payment is due, during which the policyholder may still make a payment. The policy remains in effect during the grace period.
Group Insurance - A contract between an insurer and an employer or association.
Guarantee Issue - A type of health insurance policy that is issued regardless of health.
Guaranteed Renewable - An agreement by an insurance company to insure a person for as long as premiums are paid.
HIPAA (Health Insurance Portability and Accountability Act) - Federal law that guarantees health care plan eligibility for people who change jobs, if the new employer offers group insurance.
Health Insuring Corporation (HIC) - A term for certain managed care insurers in Ohio, including all HMOs. The Department of Insurance regulates HICs.
Health Maintenance Organization (HMO) - A managed care plan that provides comprehensive care for a monthly premium. Office visits with your doctor usually require a copayment. You must live in an HMO's service area to join. You usually must use the plan's providers and facilities before the plan will pay its share for covered health services.
Health Savings Account (HSA) - A savings fund that allows the insured to pay for medical expenses with pre-tax dollars. Such an account must be paired with a high-deductible health plan.
High-deductible Health Plan - A health plan for which you accept a more expensive deductible. Because you take more risk, you pay a lower premium.
Hospital Indemnity Policy - Pays a fixed dollar amount for each day you are in the hospital, regardless of actual hospital bills.
Inpatient - A person who has been admitted to a hospital or other health care facility to receive diagnosis, treatment or other health services.
Insured - An individual or organization protected by an insurance policy.
Lifetime Maximum - The total amount a policy will pay for covered expenses during an insured's lifetime.
Long-term Care (LTC) insurance - Insurance that pays for care given in a skilled nursing facility, adult care facility or at home. Covers chronic medical conditions and helps with activities of daily living.
Loss - The basis for a claim under an insurance policy. In health insurance, loss can refer to medical expenses (or, in a disability policy, loss of income) resulting from illness or injury.
Loss Ratio - The dollar amount an insurer pays in claims compared to the amount it collects from all customers in premiums. Loss ratio is usually the percentage of each dollar collected in premiums which is paid out in claims.
Medically Necessary - Treatments or services an insurance policy will pay for as defined in the contract. Check your policy for specific language defining medically necessary.
Multiple Employer Welfare Arrangement (MEWA) - An organization of employers who join together as a group to provide health care benefits for their employees. Ohio law requires a MEWA to either buy an insurance policy that covers its members' employees, or meet the financial standards for an insurance company.
Open Enrollment - A period of time when new subscribers may enroll in a health insurance plan regardless of their health.
Out-of-State Group Policies - A group policy that is sold outside of Ohio. Example: you live in Ohio and are covered by a policy your group purchased in Indiana. The policy may be regulated by Indiana law rather than Ohio law.

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