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Blue Care Network
Blue Cross Blue Shield
Medicare Part C Plans
Physicians Care Network
Physicians Health Plan
Preferred Choices PPO
Private Health Care Systems
United Health Care
Deductible: A fixed dollar amount during the benefit period that an insured person is responsible for paying before the insurance carrier makes payment for covered services
Coinsurance: A form of cost sharing in a health insurance plan that requires an insured person to pay a percentage of medical expenses after the deductible has been paid
(ie: 80/20 plan – insurance company pays 80% of the covered charges and the patient is responsible for 20% of the covered charges)
Copayment: A form of cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurance carrier is responsible for the rest of the reimbursement. (ie: $20 copay per visit)
Maximum out-of-pocket expense (MOP): Maximum dollar amount a group member is required to pay out of pocket during a year. Until the max is met, the carrier and the insured share the cost of covered expenses. After the max is reached the carrier pays all covered expenses up to a lifetime max.
Precertification: Authorization to deliver a healthcare service that is issued before any service is rendered.
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