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Authorization for the insurance company to send insurannce payments directly to the health care provider; also, an agreement with Medicare that the provider will accept the remittance as full payment.
Assignment of benefits
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A person eligible to receive insurance benefits.
Beneficiary
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A method used to determine the primary insurance carrier when children are covered under both parents' insurance plans; the parent whose birthday falls earliest in the calendar year becomes the primary carrier.
Birthday Rule
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A health care insurance payment made to a provider based on a fixed amount per enrollee assigned to that provider, regardless of serviced provided.
Capitation
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Insurance company that provides the policy and benefits.
Carrier
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Service benefit program with no premiums for select family members of specific veterans, spouses and dependents of military personnel with permanent, total, service related disability or spouses and dependents of military personnel who died from a service-related injury.
CHAMPVA
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Fixed percentage of covered charges contractually assumed by the insured party.
Coinsurance
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Small fixed fee that is collected at the time of the visit.
Copayment
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Fixed dollar amount that must be paid, "met" once a benefit year, before the insurance company begins to cover medical expenses.
Deductible
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A person covered under the primary insured's policy.
Dependent
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Conditions or circumstances that are not covered under the insurance plan.
Exclusion
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A claim summary indicating what services were covered, what was not covered, and why; also referred to as a remittance advice.
Explanation of benefits (EOB)
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A payment made to the health care provider for each service rendered.
Fee for Service
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A list of a physician's customary charges; may incorporate insurance plan specific discounts.
Fee schedule
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An association that provides all care to the insured person for a fixed fee, usually paid for by the insured or employer through a monthly premium; a copayment may or may not be required.
Health Maintenance Organization (HMO)
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Plan through which the insured person selects his or her own health care providers; an established amount or percentage of care cost is paid by the insurance plan on a fee for service basis; usually has deductibles and limits.
Indemnity
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