Health Care Glossary of Terms

  • Fee-for-service:Traditional health care coverage where the patient or insurance company is billed for services provided.

    Managed care: 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.

    Medicaid: A program of health insurance provided by the state and federal government for the poor, elderly and disabled.

    Medicare: 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.

    Private insurance: Traditional health care coverage purchased from an insurance company. Gives you free choice of physicians, hospitals and other health care facilities.

    Premium: The amount paid for any insurance policy.

    Pre-existing condition: 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 instate toll-free line, 1-877-888-4877.