Health Insurance Procedures Ch.19 Vocab

Front 1

Allowed Charge

Back 1

The allowed maximum amount the insurance company will pay

Front 2

Authorization

Back 2

An approved referral

Front 3

Beneficiary

Back 3

Someone who is insured by an insurance policy

Front 4

Capitation

Back 4

The provider is paid a fixed amount for each individual enrolled in the plan during a specified time period

Front 5

TRICARE(CHAMPUS)

Back 5

Dependents of military personnel

Front 6

CHAMPVA

Back 6

Federal insurance for the surviving spouses and dependent children of veterans who died as a result of service related dissabilities

Front 7

Co-insurance

Back 7

Found in medical insurance where the policy holder and the insurance company share the cost of covered losses in a specified ratio

Front 8

Co-payment

Back 8

A sum of $ that is paid at the time of medical service

Front 9

Deductable

Back 9

An amount of $ a patient must pay b-4 an insurance company begins paying (yearly or per incident basis)

Front 10

Disability Income Insurance

Back 10

Payments to replace income of the insured is unable to work as a result of illness, injury, or disease

Front 11

Eligibility

Back 11

Describes whether a patients insurance coverage is in effect and eligible for payment of insurance benefits

Front 12

EOB (Explaination of Benefits)

Back 12

Letter from insurance carrier describing what was paid, denied, or reduced in payment. (Also states amount applied to the deductible, the patients co-insurance, and the allowed amounts)

Front 13

EOMB(Explaination of Medicare Benefits)

Back 13

Same as EOB, except with Medicare

Front 14

Fee for Service

Back 14

An established schedule of fees set for services performed by the providers and paid by the patient

Front 15

Group Policy

Back 15

Insurance written under a policy that covers a number of people under a single master contract issued to their employer

Front 16

Guarantor

Back 16

Person who is responsible for paying a medical bill