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Understand the Rules of the Game 

So what do all those terms mean anyway?


Claim - Reimbursement request submitted to an insurer from a patient or provider (such as a doctor or nurse practitioner) for health care services.

Co-insurance - The amount you are charged for some covered medical services, based on a percentage of the cost of that service. For example, if your plan requires a 20% co-insurance for a prescription that costs $100, you will be paying $20 or 20% of the cost.

Co-pay - A flat fee of cost charged to the patient for a health care service or product.

Deductible - Amount a patient must pay each year for health care services before the health care plan will start paying for health care costs.

Health Maintenance Organization (HMO) - An organization that provides well care, with the idea that a doctor can identify health issues before you become acutely ill.

Health Savings Account - An account in which you agree to place a portion of your salary, pre-tax, to help you pay for some health care expenses, like a co-pay or deductible.

Managed Care - A health care program that manages cost in providing care to you

Preferred Provider Option - A list of doctors from whom your insurance company wants you to receive care.

Preferred Provider Organization (PPO) - A type of health plan that limits the network of providers and facilities you can get care at for a lower price. In a PPO, you may use providers outside the network but it will cost you more.

You can learn more on MedlinePlus from the U.S. National Library of Medicine at the National Institutes of Health.

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Updated: 1/4/2013