Navigating the Health Insurance Landscape by Robert Adziashvili - HTML preview

Navigating the Health Insurance Landscape

Credi t abl e Presc ri pt i o n D rug Co v erage: Presc ri pt i o n drug c o v erage ( fo r exampl e fro m an empl o yer o r un i o n ) t hat 's expec t ed t o pay, o n av erage, at l east as muc h as Medi c are's st an dard presc ri pt i o n drug c o v erage.

Cri t i c al Il l n ess In suran c e: In suran c e t hat pays a set amo un t i f yo u hav e o n e o f t he i l l n esses spec i fi ed i n t he po l i c y.

CS R ( Co st -S hari n g Reduc t i o n ) : D i sc o un t s t hat l o wer t he amo un t yo u hav e t o pay fo r deduc t i bl es, c o paymen t s, an d c o i n suran c e.

D educ t i bl e: The amo un t yo u o we fo r heal t h c are serv i c es befo re yo ur heal t h i n suran c e begi n s t o pay.

D epen den t Co v erage: In suran c e c o v erage fo r fami l y members o f t he po l i c yho l der, suc h as spo uses, c hi l dren , o r part n ers.

D RG ( D i agn o si s-Rel at ed Gro up) : A syst em t hat c l assi fi es an y i n pat i en t st ay i n t o gro ups fo r t he purpo ses o f paymen t .

D urabl e Medi c al E qui pmen t ( D ME ) : E qui pmen t an d suppl i es o rdered by a heal t h c are pro v i der fo r ev eryday o r ext en ded use.

E PO ( E xc l usi v e Pro v i der O rgan i z at i o n ) : A man aged c are pl an where serv i c es are c o v ered o n l y i f yo u use do c t o rs, spec i al i st s, o r ho spi t al s i n t he pl an ’ s n et wo rk ( exc ept i n an emergen c y) .

E ssen t i al Heal t h Ben efi t s: A set o f heal t h c are serv i c e c at ego ri es t hat must be c o v ered by c ert ai n pl an s, st art i n g i n 2 0 1 4 .