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ASO (Administrative Services Only) -
An arrangement in which an employer hires a third person to do administrative services which includes claims processing and billing.
Coinsurance -
A type of a health insurance plan in which an insured person has to bear a stated percentage of medical expenses.
Copayment -
In this type of health insurance plan the insured individual has to pay a fixed amount of money very time a medical service is received. The insurance company will have to pay leftover amount, if any.
Deductible -
A fixed money payment during the benefit period which an insured individual pays before the insurer begins making payments for covered medical services.
Flexible spending accounts or arrangements (FSA) -
Employees are required to pay a specific amount of money to pay for the employee's share of insurance premiums or medical expenses not covered by the employer's health plan.
Gatekeeper -
A person who has been authorised to look after the patient's treatment; and to co-ordinate all medical services, laboratory studies, specialty referrals and hospitalizations.
Association Health Plans -
It can be used to refer to a health insurance plan sponsored by an association.
Basic Medical Insurance -
Plan that covers a specific hospital, surgical, and other expenses such as cost of x-rays, anesthesia, operating room, and fee for doctor visits.
Basic Premium-
A part of the total premium that covers the initial administrative expenses the insurance company incurs while making your policy.
Benefit Period -
The interval in which you are able to receive benefits. Usually, it starts with medical service received for an illness and ends after the patient has not been hospitalized for 60 consecutive days.
Elimination Period-
The period of time when no benefits are received during a stay in a long-term care facility.
Pre admission certification - An authorization letter given by the insurance company to the insured which authorises him/her a permission to use that hospital covering all reimbursement benefits.
Utilization review -
This review is done by the professionals to check if the patient has been provided appropriate care at the right time.
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