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Coinsurance
- The amount you are required to pay to share the cost of covered
services. The coinsurance rate is usually a percentage. For example,
if the insurance company pays 80% of the claim, you pay 20%.
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Coordination of Benefits
- A system to eliminate duplication of benefits when you are covered
under more than one group plan. Benefits under the two plans usually
are limited to no more than 100% of the claim.
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Copayment
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Another way of sharing medical costs. You pay a flat fee for certain
medical expenses (e.g., $10 for every visit to the doctor).
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Covered Expenses
- Most insurance plans do not pay for all services (e.g., smoking deterents).
Covered services are those medical procedures that a health plan agrees to pay
for. They are listed in the policy, so be sure to check your plan for the specifics.
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Deductible
- The amount of money you must pay each year to cover your medical
expenses before your insurance policy starts paying.
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Exclusions
- Specific conditions or circumstances, listed in the policy, which
are not covered.
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Out-of-Pocket Maximum
- The most money you will be required to pay each year for deductibles
and coinsurance. It is a stated dollar amount set by the insurance
company, in addition to regular premiums.
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Member ID Card
- This card is sent to you, and identifies you as a member of a particular insurance
plan. The card provides basic information about your coverage and contact information.
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Noncancellable Policy
- A policy that guarantees you can receive insurance, as long as you pay the premium.
It is also called a "guaranteed renewable policy."
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Preferred Provider Organization (PPO)
- A type of managed care plan where coverage for expenses incurred
by a Preferred (in-network) Provider are paid at a higher level than the coverage
available for services received from an a Non-Preferred (out-of-network) Provider.
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Pre-existing Condition
- A health problem that existed before the date your insurance became
effective.
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Premium
- The amount you or your employer pays in exchange for insurance coverage.
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Provider
- Any person (i.e., doctor, nurse, dentist) or institution (i.e., hospital or
clinic) that provides medical care.
The Wisconsin Office of the Commissioner of Insurance also
provides
a comprehensive
Glossary of Insurance Terms
.
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