[su_box title=”Keep in mind…” style=”default”] Referrals play a key role in healthcare plans Plans use networks of medical care providers to deliver benefits and services for members Referrals give permission to use network resources Some plans use doctors to make referrals while others allow members to choose for themselves and Read more…
[su_box title=”Keep in mind…” style=”default”] Navigators are tasked with helping eligible consumers find coverage in the ACA Navigators only serve the interest of consumers, never insurers Navigators accommodate and educate based on the needs of the consumer Training and certification are required to become a navigator Insurers are prohibited from Read more…
[su_box title=”Keep in mind…” style=”default”] Usual, customary, and reasonable is a standard that insurers use to determine the price of a benefit or service The usual, customary, and reasonable amount can affect the consumer’s coinsurance for a covered benefit The usual, customary, and reasonable price then determines the amount of Read more…
[su_box title=”Keep in mind…” style=”default”] PD means medicines or prescription drugs in medical terms Prescription drugs are a major part of medical care and health costs in the US Combined with other letters PD represents a prescription insurance option MA-PD describes Medicare Advantage plans that offer prescription coverage [/su_box] In Read more…
[su_box title=”Keep in mind…” style=”default”] Health insurance can be paid for by employers, the government, or individuals. It often involves some level of cost sharing between these parties Out-of-pocket costs are costs that individuals have to pay either when receiving health care services or on a periodic (e.g. monthly) basis. Read more…
[su_box title=”Keep in mind…” style=”default”] Medical insurance cards are mailed by the insurance company after a policy is purchased These cards serve as proof of insurance and have a great deal of vital information printed on them You should keep your medical insurance card with you at all times [/su_box] Read more…
[su_box title=”Keep in mind…” style=”default”] A plan sponsor is typically an employer For public health insurance, the plan sponsor is the federal or state government Plan sponsors create the health care plan for a third party [/su_box] In the insurance industry, there are various parties who may set up insurance Read more…
[su_box title=”Keep in mind…” style=”default”] A policyholder is the person named on the insurance policy contract Joint policyholders have both their names on the insurance policy contract Policyholders, when it comes to group health insurance, are sometimes employers [/su_box] When discussing insurance, one of the terms that is most frequently Read more…
[su_box title=”Keep in mind…” style=”default”] Once deductibles and copayments have been met, the stop loss provision is activated This is a specific clause that is contained within any policy that has a deductible as a core component Once the stop loss provision is enacted, the insured will no longer pay Read more…
[su_box title=”Keep in mind…” style=”default”] A rider is any type of amendment to a health insurance policy They can add coverage or exclude coverage depending on a situation Since 2014, health insurance plans have not been able to include exclusionary riders in their policies [/su_box] There are a variety of Read more…
