Glossary of Terms
Traditional health care coverage where the patient or insurance company is billed for services provided.
Treatments, as well as payments, are monitored and approved or denied by the insurance company.
Health Maintenance Organization (HMO):
An HMO is a group that contracts with medical facilities, physicians, employers and sometimes individual patients to provide medical care to a group of individuals. This care is usually paid for by an employer at a fixed price per patient. Patients generally do not have any significant "out-of-pocket" expenses. The patient must see only the doctors who are members of a particular HMO. Physicians working for HMOs often are given financial incentives to decrease medical costs by limiting expensive diagnostic tests, referrals to specialists, and hospitalizations.
A program of health insurance provided by the state and federal government for the poor, elderly and disabled.
Health insurance provided by the federal government for the elderly and disabled.
Point of Service:
A health plan that allows the patient to choose the type of payment method (traditional, PPO or HMO) at the time service is received.
Traditional health care coverage purchased from an insurance company. Gives you free choice of physicians, hospitals and other health care facilities.
The amount paid for any insurance policy.
Illnesses or problems a patient had before obtaining an insurance policy. Some insurance companies may refuse to issue a policy or not pay for care for the preexisting condition or may not pay for that condition for a set period of time.
The following acronyms are often used when discussing methods of health care coverage and payment. These explanations are provided for better understanding of these terms.
HMO - Health Maintenance Organization
PPO - Preferred Provider Organization
IPA - Independent Physician Association
EPO - Employer Preferred Organization
PHO - Physician Health Organization
MSO - Medical Service Organization
POS - Point of Service
DED - Deductible
EOB - Explanation of Benefits
OOP - Out of Pocket
INS - Insurance
COP - Co-Payment
COI - Co-Insurance
OEP - Open Enrollment Period
BUO - Buy-Up Options
PCS - Prescription Card Services
You can contact the Health Care Section at 1-717-705-6938 on weekdays from 8:30 AM until 5:00 PM. The Section also has a toll-free line, 1-877-888-4877, which operates within Pennsylvania on weekdays between the hours of 8:30 AM and 9:00 PM.