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Annual Cost:
The yearly amount you pay for approved benefits.
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Annual Maximum
Amount: The yearly amount your plan will pay for approved
benefits.
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Carrier:
The insurance company (i.e. Humana - not Corporate Benefit
Solutions.)
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Claim: A
bill submitted to your carrier for payment.
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Copay:
The amount you pay for a benefit (i.e. prescriptions/office visits -
$10, $20, $30, etc.)
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Coinsurance:
The percentage of costs you pay for a covered service (i.e. 10%,
20%, 30%, etc.)
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Coordination of
Benefits (COB): Your insurance company combined with
another (spouse) insurance company.
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Deductible:
The amount you pay first before your insurance company pays for your
service.
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Dental Maintenance
Organization (DMO): A network where you choose one
participating dentist.
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Effective Date:
The day and month your benefits are activated.
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Explanation of
Benefits (EOB): Information you receive explaining how your
claim was processed.
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Health Maintenance
Organization (HMO): A network where you choose a primary
care physician.
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In-Network:
A group (network) of doctors, labs, or hospitals that 'participate'
with network carriers, and agree to accept the payment offered by
the insurance carrier.
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Mail Order Drugs:
Prescription drugs that can be ordered and received through the
mail.
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Maintenance Drugs:
Prescription drugs that must be taken regularly (i.e. insulin, high
blood pressure, etc.)
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Out-of-Network:
Doctors, labs, or hospitals that do not 'participate' with some
insurance carriers.
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Primary Care
Physician (PCP): A network doctor that you choose who
participates in a network plan.
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Point of Service
(POS): An HMO with a self-referral option that allows you
to go out of the network.
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Preferred Provider
Organization (PPO): A network plan of doctors, labs, and
hospitals.
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Provider:
The doctor, lab, or hospital (i.e. 'participating' providers in HMO,
POS, or PPO plans.)
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Reimbursement:
The amount returned to you, after a claim form has been submitted
for payment.
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Traditional:
You can usually choose any doctor or hospital for service.
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Voluntary:
You agree to pay for the insurance coverage offered through your
employer.