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annual out-of-pocket maximum - The maximum amount, per year, you are required to pay out of your own pocket for covered health care services after the deductible is met. claim - An itemized bill for services that have been provided to a subscriber, a subscriber's spouse or dependents. copayment - A fixed dollar amount you are required to pay for covered services at the time you receive care. covered service - A service which is covered according to the terms in your health care benefits plan. dependent - An eligible person, other than the member (generally a spouse or child), who has health care benefits under the member's policy. Health Insurance Portability and Accountability Act (HIPAA) - A federal law that outlines the rules and requirements employer-sponsored group insurance plans, insurance companies and managed care organizations must follow to provide health care insurance coverage for individuals and groups. Health Risk Assessment (HRA) - An assessment of a health care plan member's health status by taking into account that person's family health history and health-related behaviors to predict the member's likelihood of experiencing certain health issues. individual coverage - Health care coverage for an individual with no covered dependents. inpatient services - Services provided when a member is registered as a bed patient and is treated as such in a health care facility such as a hospital. maximum annual benefit - The maximum dollar amount your health care plan will pay for health care services provided to you during one year. member ID - A unique number that identifies you as a member of a particular health care plan (also known as an ID number or subscriber ID). network - The group of doctors, hospitals and other medical care professionals that a managed care plan has contracted with to deliver medical services to its members. out-of-pocket maximum - The maximum amount you have to pay for expenses covered under your health care plan, after any deductible is met, during a defined benefit period. outpatient services - Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility. pre-existing condition - A health condition for which an individual received medical care during a specified period of time immediately prior to the effective date of coverage. |
