Health Insurance Glossary

CHIP (Children's Health Insurance Program) - A program, established by the Balanced Budget Act, designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs.

Claim Form - An application for payment of benefits under your health plan.

COBRA (Consolidated Omnibus Budget Reconciliation Act) - A federal act which requires each group health plan to allow employees and certain dependents to continue their group coverage for a stated period of time following a qualifying event that causes the loss of group health coverage. Qualifying events include reduced work hours, death or divorce of a covered employee, and termination of employment.

Co-insurance provision - A stipulation found in most health insurance policies that requires an insured to pay a stated percentage, in excess of the deductible, of all eligible medical expenses.

Health Insurance - It is a type of insurance policy that pays a pre-negotiated percentage of a policy holder's covered medical treatments.

HIPAA - The Health Insurance Portability and Accountability Act, enacted in 1996, AND Created a new national standard in protecting your health information.

HMO (Health Maintenance Organization) - Prepaid health plans in which you pay a monthly premium and the HMO covers your necessary medical treatment. You must choose a primary care physician from within the network to coordinate all of your care. All specialty referrals need to be authorized by your primary care physician.

MCO (managed care organization) - Any entity that utilizes certain concepts or techniques to manage the accessibility, cost, and quality of healthcare. Also known as a managed care plan.

MSO (Management Services Organization) - An organization, owned by a hospital or a group of investors, that provides management and administrative support services to individual physicians or small group practices in order to relieve physicians of non-medical business functions so that they can concentrate on the clinical aspects of their practice.

PHO (Physician-Hospital Organization) - A joint venture between a hospital and many or all of its admitting physicians whose primary purpose is contract negotiations with MCOs and marketing.

Policy - A written document that serves as evidence of an insurance contract and contains the specific facts about the policyowner, the insurance coverage, the insured, and the insurer.

PPA (Preferred Provider Arrangement - As defined in state laws, a contract between a healthcare insurer and a healthcare provider or group of providers who agree to provide services to persons covered under the contract. Examples include preferred provider organizations (PPOs) and exclusive provider organizations (EPOs).

PPO (Preferred Provider Organization) - A network of health-care providers with which a health insurer has negotiated contracts for its insured population to receive health services at discounted costs. Health-care decisions generally remain with the patient as he or she selects providers and determines his or her own need for services. Patients have financial incentives to select providers within the PPO network.

Premium - The monthly amount you or your employer pays in exchange for insurance coverage.

PSO (Provider-Sponsored Organization) - A healthcare organization that is established and organized, or operated, by a healthcare provider or a group of affiliated healthcare providers to arrange for the delivery, financing, and administration of healthcare, that meets requirements established by the Balanced Budget Act of 1997 and that has the authority to contract directly with Medicare.