Navigating the Health Insurance Landscape by Robert Adziashvili - HTML preview

Navigating the Health Insurance Landscape

Cat ast ro phi c Co v erage: Heal t h i n suran c e c o v erage t hat pro t ec t s agai n st hi gh medi c al c o st s fo r sev ere i n juri es o r i l l n esses.

Presc ri pt i o n D rug Co v erage: Heal t h i n suran c e c o v erage t hat hel ps pay fo r t he c o st o f presc ri pt i o n medi c at i o n s.

Fo rmul ary: A l i st o f presc ri pt i o n drugs c o v ered by yo ur i n suran c e pl an .

Gen eri c D rug: A medi c at i o n t hat i s c hemi c al l y equi v al en t t o a bran d-n ame drug but t ypi c al l y c o st s l ess.

Bran d-Name D rug: A medi c at i o n t hat i s so l d un der a spec i fi c n ame o r t rademark .

Ac t uari al Val ue: The perc en t age o f t o t al av erage c o st s fo r c o v ered ben efi t s t hat a pl an wi l l c o v er.

Appeal : A request fo r yo ur heal t h i n surer o r pl an t o rev i ew a dec i si o n t hat den i es a ben efi t o r paymen t .

Ben efi t s: The heal t h c are i t ems o r serv i c es c o v ered un der a heal t h i n suran c e pl an .

Bun dl ed Paymen t : A si n gl e paymen t t o pro v i ders o r heal t h c are fac i l i t i es fo r al l serv i c es t o t reat a gi v en c o n di t i o n .

Capi t at i o n : A paymen t arran gemen t fo r heal t h c are serv i c e pro v i ders where t hey rec ei v e a set amo un t fo r eac h en ro l l ed perso n assi gn ed t o t hem, per peri o d o f t i me, regardl ess o f whet her t hat perso n seek s c are.