Health insurance terms can be confusing. Understanding this glossary can make managing the financial aspects of your care easier.
| Term | Definition |
|---|---|
| 共同保险 | The portion of healthcare services the member is responsible for. Usually on an 80% covered, 20% not covered basis. |
| Co-Payment | 固定金额每次访问健康计划提供商并获得服务时，成员支付的费用（通常在5至25美元之间）。 |
| Deductible | A fixed amount the member must pay each year before the insurer will begin covering the cost of care. |
| Health Maintenance Organization (HMO) | An organization that provides health care through a network of doctors, hospitals and other medical professionals. HMO members must use the network to be covered for that care. HMOs are a part of Managed Care. |
| Identification Card | A card certifying member as enrolled in a health plan and entitled to benefits. This card must be presented upon each visit to your PCP or when seeing a specialist that you have been referred to. |
| 医学上必要的服务 | Covered services required to preserve and maintain the health status of a member based on established medical practice standards. These are primarily determined by your health plan. |
| Member | Anyone enrolled in an HMO and entitled to receive benefits. |
| Network | The doctors, clinics, health centers, medical group practices, hospitals, and other providers that an HMO, PPO, or other managed care network has selected and contracted with to care for its members. |
| Out-of-Network | 不在HMO的选择和批准的医生和医院网络中。在许多情况下，如果成员选择去网络外，则不会为此付费，否则将受到成员负责支付的罚款。 |
| 服务点（POS） | A type of HMO coverage that allows members to see providers outside of the network, usually at a slightly higher co-payment or deductible cost. |
| Preferred Provider Organization (PPO) | Slightly different from the typical HMO in that visits to specialists usually do not require authorization by a PCP. Also, unlike most HMOs, out-of-network usage is allowed by PPOs, though at a higher cost to the member. |
| Preventative Care | Predetermined course of care designed to prevent disease altogether, to detect and treat it early, or to manage its course most effectively. Examples of preventive care include immunizations and regular screenings like Pap smears or cholesterol checks. |
| Primary Care | 通常由接受内科医学，儿科或家庭实践培训的医生或护士，护士从业者或医师的助理提供的医生提供的预防性医疗保健和常规医疗保健。 |
| Primary Care Physician (PCP) | 通常由接受内科医学，儿科或家庭实践培训的医生或护士，护士从业者或医师的助理提供的医生提供的预防性医疗保健和常规医疗保健。 |
| Pre-Authorization | Certain HMO services require health plan authorization before service is rendered. |
| 提供者 | Medical professional that provides covered services approved by the health plan's contract. Providers include: physicians, pharmacies, hospitals, etc. |
| Referral | A formal process that authorizes an HMO member to receive care from a specialist or hospital. To assure coverage, an HMO member generally must get a referral from his or her primary care doctor before seeing a specialist. |
| Specialist | 医生或其他保健专业的training and expertise are in a specific area of medicine, like cardiology or dermatology. Most HMOs require members to get a referral from their primary care physician before seeing a specialist. |