GlossaryHealth InsuranceF to H
You will find an expanded list and definition of terms in this glossary health insurance F to H section.
Use it often, especially when you begin to review your health insurance policy and benefits.
F
fee schedule: A payment structure used by the insurance company that
places caps or limits on the dollar amounts that it will reimburse your providers for the covered medical services and
procedures, both in and out-of-network if applicable.
fee-for-service reimbursement: Unlike the fee schedule, this is a method of payment for each visit or service rendered based on your provider’s own charges or through a "usual, customary
and reasonable" standard of payment.
Flexible Spending Account (FSA): An employee benefits plan that allows
you to have money withheld from your paychecks on a pre-tax basis, and use this money for qualified medical or
dependent expenses not covered by your employer’s plan or insurance contract.
You however forfeit any unused funds at the end of each calendar year. This plan is also called Flex Plan or a Cafeteria Plan.
flex-term medical coverage: See "short-term medical coverage."
fully insured plan: A group insurance plan for which an insurance company bears the responsibility of making all claim payments.
fully self-insured plan: A group insurance plan under which the employer
takes complete responsibility for all claim payments and related expenses rather than
purchasing coverage from an insurance company.
G
gatekeeper physician: Your chosen primary care physician in an HMO who is
responsible for referring you to specialists and for supervising your medical care and treatment.
grace period: A specified period immediately following the premium due
date during which you can still make a payment to keep your policy in force without interruption.
guaranteed renewable policy: The requirement your insurance company
renews your policy at the end of a specified time if you choose to do so.
Your insurance company may increase the
premium rate for any class of guaranteed renewable policies. Also called non-
cancellable policy.
H
health alliances: State-sanctioned entities whose primary purpose is to
negotiate with health plans to provide coverage at competitive prices to members of the alliance. Also called Health
Insurance Purchasing Cooperatives (HIPCs).
health care provider: A doctor, hospital, laboratory, nurse or anyone
else who delivers medical or health-related care.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): A
1996 law intended to make employer-provided health insurance more "portable" by allowing continuously covered employees leaving a company to get a coverage from a new group or individual insurance without
having to wait through an exclusion period.
HIPAA also established a guaranteed issue in group insurance and included a Medical Savings Account demonstration project.
Health Savings Account (HSA): A tax-favored savings account used with a high deductible medical plan that allows you to pay for qualified medical expenses with pre-tax dollars and save for retirement on a tax-deferred basis. Any HSA funds not used each year remain in the account earning interes tax-free to supplement future medical expenses.
home health care: Skilled medical care and other health care services
(such as nursing care, and speech, occupational or physical therapy) that you receive in your home for the treatment of
an illness or injury.
Not all plans provide this kind of coverage, or some may provide it but only for a limited amount of time.
hospital indemnity insurance: Health insurance offers limited coverage.
It provides you a stipulated daily, weekly or monthly payment during hospital confinement (up to a maximum number of days), without regard to the actual accrued expenses.
hospital medical insurance: Coverage that pays for the cost of any or all
hospital services normally covered under various health care plans.
Health Care Financing Administration: The administration that oversees
Medicare and Medicaid and also sets standards health care providers must meet in order to become certified as a qualified Medicare provider.
hospice care: Care given on a regular basis to terminally ill patients.
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