You may be billed the difference between what your insurer pays and the fee your provider normally charges.
The person who is eligible to have health insurance through the Medicare or Medicaid program.
The amount that has been paid for a covered person during the calendar year or plan year.
Benefit period (Medicare)
The time during which you are admitted and treated at a hospital or skilled nursing facility. The benefit period begins the day you go to the facility and ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins.
Benefit plan document
A generic term for a legal document detailing a member's or group's coverage. This document is usually referred to as a Certificate of Coverage, Certificate of Insurance, Summary Plan Description, individual policy or Evidence of Coverage.
The care, items and services covered by an insurance plan.
The dollar amount you may be responsible for paying to the doctor or hospital when you use an out-of-network provider.
The highest dollar amount, number of visits or services your health plan will pay toward your covered expenses over the course of a plan year.
An outline of all the benefits covered by your plan.
A physician who has graduated from medical school, completed residency, trained under supervision in a specialty and passed a qualifying exam given by a medical specialty board.