Health insurance is a type of insurance that provides protection against the risk of financial loss resulting from the insured person's sickness, accidental injury, or disability.

What are the Different Types of Health Insurance Coverage?

1. Medicare
   
   1. Generally, Medicare is available for people age 65 and older, younger people with disabilities, and people with End-Stage Renal Disease. Medicare has two parts, Part A (Hospital Insurance Coverage), and Part B (Outpatient Insurance Coverage). The annual deductible for outpatient services is $100.00 per calendar year. Once your deductible has been met, they reimburse at 80% of the pre-approved set amount for each charge, leaving the patient responsible for their 20% co-insurance. Their number is 1-800-772-1213 to enroll.
2. HMO's (Health Maintenance Organization)
   
   1. It is a health care financing delivery system that provides comprehensive health care for subscribing members in a particular geographic are using managed care techniques. Most HMO's require that you only utilize physicians in their network, often going so far as to require you to choose a primary care physician who directs most courses of your treatment.
3. PPO (Preferred Provider Option)
   
   1. It is an organization where providers are under contract to an insurance company or health plan to provide care at a discounted or negotiated rate. Typically, you can see any doctor in the PPO network without requiring special approval, and you usually do not need to choose a primary care physician. Most PPO's will also allow you to seek care outside of the PPO network; however, the benefits are usually reduced and the insured has a greater out-of-pocket expense.
4. Commercial Insurance
   
   1. This is normally an insurance that an employer would be offering to its employees, or even purchased privately though an individual agent. There are no restrictions as to where services can be rendered, though there is usually a significant deductible and out-of-pocket expense that must be met before services will be covered and paid by your insurance.
5. Medicaid/EDS
   
   1. This is a government-funded program for individuals or families meeting a specific income requirement or that has a defined disability.

Annual out-of-pocket maximum: A dollar amount set by the plan which puts a cap on the amount of money the insured must pay out of his or her own pocket for covered expenses over the course of a calendar year.

Claim: A request for payment under the terms of an insurance policy.

Claim examiner: An insurance company employee who is responsible for carrying out the claim examination process. Also known as a claim approver, claim analyst, or claim specialist.

Coinsurance provision: A specified percentage of the cost of treatment the insured is required to pay for all covered medical expenses remaining after the policy's deductible as been met.

Copay: (1) A fee that many insurance plans require an insured to pay for certain medical services (such as a physician's office visit). (2) An amount that the insured must pay toward the cost of each prescription under a prescription drug plan.

Deductible: A flat amount of covered medical expenses that an insured must incur before the insurer will make any benefit payments under a medical expense policy.

Lifetime maximum: The maximum amount of money a plan will pay towards healthcare services over the course of the insured's lifetime.

Major medical insurance plan: A type of traditional medical expense coverage that provides substantial benefits for hospital surgical expenses and physicians' fees.

Managed care: A method of integrating the financing and delivery of health care within a system that seeks to manage the cost, accessibility and quality of care.

Network: A group of doctors, hospitals and other health-care providers contracting with a health plan, usually to provide care at special rates and to handle paperwork with the health plan.

Out-of-network: Health care services rendered outside the HMO or PPO network.

Out-of-pocket expense: Any medical care costs not covered by insurance, which must be paid by the insured.

Pre-existing condition: (1) According to most individual health insurance policies, and injury that occurred or a sickness that first appeared or manifested itself before the policy was issued and that was not disclosed on the application for insurance. (2) According to most group health insurance policies, a condition for which an individual received medical care during the three months immediately prior to the effective date of his coverage.

Primary care physician (PCP): A general or family practitioner who serves as the insured's personal physician and first contact with a managed care system. The PCP will usually direct the course of your treatment and/or refer you to other doctors and/or specialists in the network.

Usual, customary and reasonable fee: The maximum dollar amount of a covered expense that is considered eligible for reimbursement under a major medical policy.