A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment. A term that describes a shared payment between an insurance company and an insured individual. Under many plans, co-payments are made at the time of the service and the health plan pays for the remainder of the fee. For example, under some plans generic prescriptions are covered expenses while brand name prescriptions are not.
Deductibles are standard in many indemnity policies, and are usually based on a calendar year.
A term that typically refers to an HMO, Point of Service, EPO, or PPO, but technically means any health plan with specific requirements, like pre-authorization or second opinions that enable your primary care physician to coordinate or manage all aspects of your medical care. The most money you can expect to pay for covered expenses. The maximum limit varies from plan to plan. A specified period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date, usually the next month. Open enrollment usually comes once per calendar year.