Health insurance is becoming more and more complicated. Here are some of the things you need to understand about health insurance.
Primary Care Physician
The doctor in your HMO network who coordinate the member's medical care. Your primary care physician provides you with routine medical care and will refer you to a specialist when necessary. In other words, your personal doctor.
Health Care Provider. A doctor, hospital, laboratory, nurse or anyone else who treats you for a medical or health condition.
Pre-existing Conditions. A health condition for which medical advice, diagnosis, care or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during a specified period of time immediately preceding the effective date of health insurance coverage.
Co-payment. A type of cost sharing where persons who have health insurance pay a specified fee for service or a percent of the amount allowed as reimbursement for a covered service. Also referred to as "co-insurance".
Deductible. An amount the insured person must pay before health insurance payments for covered services begin. There may also be other, separate deductibles that apply to certain types of services.
Exclusions. Conditions, situations, and services not covered by the health insurance plan.
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