10-12-2022 PTL - Flipbook - Page 29
A Special Advertising Section of Baltimore Sun Media Group | Wednesday, October 12, 2022
29
Health glossary, continued
from previous page
Unlike other plans, if you enroll in a
catastrophic plan, you won’t be eligible for
tax credits that may lower your premium
costs, or for other savings. To qualify for
a catastrophic plan, an individual must be
under 30 years old or receive a hardship
exemption, which is a determination that
they are unable to afford health coverage.
Claim
A request for payment that you or
your health care provider submits to your
health insurer after you receive items or
services you think are covered.
Coinsurance
Your share of the costs of a covered health care service, calculated as
a percent of the allowed amount for the
service. You pay coinsurance plus any
deductibles you owe. For example, if the
health insurance or plans allowed amount
for an office visit is $100 and you’ve met
your deductible, your coinsurance payment of 20% would be $20. The health
insurance or plan pays the rest of the
allowed amount.
Copayment
An amount you may be required to pay
as your share of the cost for a medical
service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug.
A copayment is usually a set amount,
rather than a percentage. For example,
you might pay $10 or $20 for a doctor’s
visit or prescription.
Cost Sharing
The share of costs covered by your
insurance that you pay out of your own
pocket. This term generally includes
deductibles, coinsurance and copayments, or similar charges, but it doesn’t
include premiums, balance billing amounts
for non-network providers, or the cost of
non-covered services.
Deductible
The amount you owe for health care
services your health insurance or plan
covers before your health insurance or
plan begins to pay.
Emergency Services
Evaluation of an illness, injury, symptom or condition so serious that a reasonable person would seek care right away
and treatment to keep the condition from
getting worse.
Essential Health Services
All plans offered on Maryland Health
Connection must cover these health benefits, such as hospitalizations, doctor visits, prescription drugs, rehabilitation and
mental health services, maternity and
newborn care, as well as emergency care,
pediatric care, including dental and vision
benefits and laboratory tests. All plans
also cover preventive and wellness care,
as well as chronic disease management,
at no extra cost to you, including: flu and
pneumonia shots, birth control, routine
vaccinations and screenings for cancer,
such as mammograms and colonoscopies.
Exclusive Provider Organization (EPO)
A type of health insurance plan where
services are covered only if you use
doctors, specialists or hospitals in the
EPO’s network (except in an emergency).
Members do not require referrals to see a
specialist.
Excluded Services
Health care services that your health
coverage or plan doesn’t pay for.
Explanation of Benefits (or EOB)
A summary of health care charges that
your insurance company sends you after
you see a provider or get a service. It is
not a bill. It is a record of the health care
you or individuals covered on your policy
got and how much your provider is charging your insurance company.
Flexible Spending Account/Flexible
Spending Arrangement
A health Flexible Spending Account
(called a Flexible Spending Arrangement
by the IRS) allows employees to be reimbursed for medical expenses. FSAs are
Health glossary,
continued on next page
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