Home HSA Insurance Group Health Insurance Meet Andy Contact Us FAQ • Glossary • Sitemap     Ask Andy for Health Insurance Advice Glossary of Common Health Insurance Terms All  A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  0  1  2  3  4  5  6  7  8  9    All Actuary A hired mathematician at a health insurance company who evaluates the company’s or client’s financial risks. Back to Top Admitting Privileges A doctor’s right to admit patients to a hospital. Back to Top Agent A licensed salesperson representing one or more health insurance companies. All our agents at our independent insurance agency in St. Pete, FL, are licensed and can help you choose the right insurance plan for you. Back to Top Benefit The amount payable to a claimant, assignee, or beneficiary by an insurance company whenever the insured suffers a loss. Back to Top Broker A licensed insurance salesperson who finds insurance quotes from multiple sources and provides insurance information for clients. Back to Top Carrier The insurance company or HMO provider offering a health plan. Perfect Health in St. Pete has access to a wide variety of health insurance and property and casualty carriers licensed to do business in the state of Florida. Back to Top Certificate of Insurance The printed description of the benefits and coverage provisions that forms the contract between the carrier and customer for car, health, vision, disability, life, dental, or other types of insurance. Back to Top Claim A request by an individual to an insurance company for the insurance company to pay for services from a health care professional. Back to Top Co-insurance A joint assumption of risk, by either two underwriters or an underwriter and the policy holder. Back to Top Co-payment A predetermined fee for health care services that an individual pays in addition to services the insurance covers. Back to Top Consolidated Omnibus Budget Reconciliation Act (COBRA) Federal legislation that lets you continue to purchase health insurance for up to 18 months after you lose your job or your coverage is terminated. Back to Top Credit for Prior Coverage A pre-existing condition waiting period met under while you were under an employer's coverage can be honored by your new plan, if any interruption in the coverage between the two plans meets state guidelines. Back to Top Deductible The amount an individual must pay for health care expenses before insurance or a self-insured company covers the costs. Often, insurance plans are based on yearly deductible amounts. Our St. Petersburg agency can help you find a quality plan with a deductible that works with your budget. Back to Top Denial of Claim Refusal by an insurance company to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional. Back to Top Dependent Worker A worker in a family in which someone else has greater personal income. Back to Top Dependents Spouse and/or unmarried children of an insured individual. Back to Top Effective Date The date your insurance coverage begins. Back to Top Exclusions Medical services that are not covered by an insurance policy. Back to Top Group Insurance Coverage through an employer or other entity that covers all individuals in the group. Read more about group health and small group health plans. Back to Top Health Maintenance Organization (HMO) Health Maintenance Organizations represent “pre-paid” insurance plans in which individuals or their employers pay a fixed monthly fee for services, instead of a separate charge for each visit or service. The monthly fees remain the same, regardless of provided service levels or types. Services are provided by physicians who are employed by, or under contract with, the HMO. Depending on the HMO type, services may be provided in a central facility or in a physician’s office. Back to Top In-network Providers or health care facilities in a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider, because those networks provide services at lower cost to the insurance companies with which they have contracts. Back to Top Indemnity Health Plan Indemnity health insurance plans are also called “fee-for-service.” These are the types of plans that primarily existed before the rise of HMOs, IPAs, and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the insurance company (or self-insured employer) pays the other percentage. For example, an individual might pay 20 percent for services and the insurance company pays 80 percent. The fees for services are defined by the providers and vary from physician to physician. Indemnity health plans offer individuals the freedom to choose their health care professionals. Back to Top Independent Practice Associations Similar to HMO, except that individuals receive care in a physician’s own office instead of a facility. Back to Top Individual Health Insurance Health insurance coverage on an individual, not group, basis. The premium is sometimes higher for an individual health insurance plan than for a group policy, but not always. If you have an individual health plan, you may not qualify for a group plan. Talk to our agents in St. Pete to find the best insurance deal. Back to Top Limitations A limit on the amount of benefits paid out for a particular covered expense. 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