Learn about the National Association of Health Underwriters (NAHU), an organization supporting professionals who service health care needs, including brokers, agents, and consultants.
Explore the role of diagnosis in health insurance, where diseases are identified through comprehensive testing and medical attention.
Learn what a Skilled Nursing Facility (SNF) is, and how it provides therapy and nursing care to patients under Medicare.
Learn about Health Maintenance Organization (HMO) health insurance plans, how they work, and the obligations for employers with more than 25 employees.
Learn about covered expenses in health insurance, including what qualifies for reimbursement or coverage under your policy. Understand the essentials for managing your healthcare costs effectively.
Learn what secondary coverage in health insurance is and how it helps cover charges not covered by a primary policy. Discover the benefits and importance of secondary health insurance coverage.
Learn about supplemental services in health insurance, the extra services you can add to basic coverage to enhance your health plan benefits.
A comprehensive guide to surgical schedules in health insurance, detailing the list of surgeries and the associated benefits.
Learn about Drug Utilization Review (DUR) in health insurance, a process that evaluates the usage and effectiveness of drug treatments to ensure optimal healthcare outcomes.
Learn about 'Open Access' in health insurance, a concept that permits policyholders to visit specialists without referrals. Explore its benefits and implications.
Learn about over-the-counter (OTC) drugs, their definition, and their relevance in general insurance. Find out how OTC drugs impact your insurance policy.
Discover the importance of the Place of Service in health insurance, including common locations like hospitals and physicians' offices. Understand how it impacts your coverage and reimbursement.
Learn what prescription medication means in the context of health insurance, and why it's essential for medications to be prescribed by a doctor.
Learn the purpose and function of a surgi-center, a facility providing surgical services on an outpatient basis. Find out how it fits within the health insurance landscape.
Explore the concept of Medical Loss Ratio in Health Insurance, which is calculated as total benefits divided by total premium. Learn its significance in the health insurance industry.
Discover what a health plan (health insurance) entails, including details on medical service coverage for members. Learn how these plans ensure access to essential healthcare.
Learn about a Home Health Agency, an essential component in health insurance, approved by and contracted to a health plan to provide certain services.
Explore the benefits of Comprehensive Health Insurance, which provides total coverage for health care-related charges, applicable after deductibles and co-insurance for hospital or physician's office visits.
Learn about Exclusive Provider Organization (EPO) health insurance plans. Discover how EPOs operate with primary care doctors and provider referrals.
Learn about mandated providers in health insurance, which are healthcare providers whose services must be legally included in health plans. Understand the importance of these regulations for comprehensive health coverage.
Learn about the Modified Fee for Service model in health insurance, where reimbursements for actual procedure costs are made up to a specific maximum. Understand its impact on healthcare payments.
Learn about out-of-area health insurance coverage, which refers to treatment provided outside the usual geographic coverage area. Get insights into how it works and what to expect.
Discover the significance of preventive care in health insurance, including examples like yearly mammograms and regular checkups, aimed at preventing illnesses.
Explore the crucial role of a Registered Nurse (Health Insurance) in providing nursing care, including medication distribution, and their importance in the healthcare system.
Explore the intricacies of risk analysis in health insurance, where benefits and premiums are tailored to fit specific groups based on comprehensive analysis.
Learn about the trend factor in health insurance, a key element that accounts for increasing costs such as the inflation of doctor’s costs and healthcare services.
Understand Triple Option health insurance plans offered by employers, providing employees with various provider types that vary in costs and coverage.
Learn about Subscriber Contracts in Health Insurance, which detail the benefits available to each registered individual. Ensure you know the key aspects of your health care plan.
Explore the process of signing people up for health insurance plans and understand the significance of enrollment numbers in healthcare coverage. Get insights into health insurance enrollment.
Learn about the Individual Practice Association (IPA) model HMO, where medical services are provided by contracted physicians within an HMO network. Understand how it functions and benefits healthcare consumers.
Learn about paid claims in health insurance, which are the amounts paid to health care providers under a health plan. Discover how these claims impact policyholders and insurers.
Learn about precertification authorization in general insurance, its importance, and how it helps in managing treatment costs effectively.
Learn what a Primary Care Network (PCN) is in health insurance, including the role of primary care doctors within a plan.
Learn how the benefit formula in health insurance calculates the amount of benefits an insured person is entitled to under an employee benefit plan.
Learn about the co-pay provision in health insurance, which defines the portion of a claim paid by the insurer and the insured.
Learn about ancillary benefits in health insurance, including coverage for hospital stay charges such as supplies, X-rays, and diagnostic tests. Understand how these benefits can support your healthcare needs.
Learn about Dental Plan Organizations (DPO) in health insurance. Understand their role in providing dental care through agreements with providers.
Discover what medically necessary procedures or treatments mean in health insurance, emphasizing their critical role in patient care and the consequences of neglect.
Learn about nonparticipating providers in health insurance, including what it means for a provider to not participate in Medicare or health plans.
Explore overage insurance, a specialized health coverage designed for individuals over 65, providing crucial health benefits even beyond the usual age limit.
Explore the concept of recidivism in health insurance, focusing on the frequency with which insured individuals are readmitted to the hospital for inpatient treatment due to the same ailment.
Learn about the Staff Model HMO, a type of Health Maintenance Organization (HMO) where premiums are paid directly to the HMO, which employs physicians who receive salaries and predetermined bonuses.
Learn about eligibility periods in health insurance, the time frame during which medical costs are reimbursed and when prospective insureds can enroll without proving insurability.
Learn about primary care in health insurance, focusing on medical care provided by a primary physician. Discover its importance and benefits.
Discover the essentials of Service Plans in health insurance, where provided services are treated as benefits rather than monetary payouts.
Understand the cost contract between health care providers and the Health Care Financing Administration, ensuring the provision of services at reasonable costs for covered individuals.
Learn about what a Free Standing Outpatient Surgical Center (FSOSC) is and how it provides outpatient services to surgical patients. Understand the role of these facilities in health insurance coverage.
Discover the essentials of health insurance, including commercial, private noncommercial, and social insurance classifications. Learn how these plans cover or share healthcare expenses.
Understand what in-area services mean in health insurance, focusing on the health care services provided within a designated geographical area as per the contract terms.
Learn what an Intermediate Care Facility is within the health insurance domain. Discover its role in caring for patients who need nursing care but do not require hospital-level attention or skilled nursing facility services.
Discover what medical supplies are deemed necessary for the treatment of illnesses or injuries and how they are covered under health insurance policies.
Medicare is a government-run and funded health insurance plan that covers hospital and medical costs for individuals typically older than 65. Learn about Part A and Part B options.
Explore the Network Model HMO in health insurance, a model that contracts with multiple physician groups allowing broader healthcare access. Learn how this model works and its benefits.
Learn about pre-admission authorization in health insurance, a required step for obtaining insurer approval before hospitalization.
Learn about Professional Corporation, a unit that offers professional services such as healthcare, within the context of general insurance terms.
Learn about the Date of Service in health insurance, which refers to the specific day a health care practitioner attends to or treats an insured individual.
A comprehensive guide to recipients in health insurance, focusing on eligibility criteria and benefits under the Medicaid program.
Comprehensive guide on the length of stay in health insurance, which refers to the total number of days an insured individual stays in a hospital or similar medical facility. Learn its impact on insurance claims and healthcare costs.
Learn who qualifies as a Medicare beneficiary according to the Social Security Administration and what it means to be eligible for Medicare benefits.
Discover Medicare Select Policy, a specialized Medicare supplement that offers benefits through a specified network of providers. Learn how it can support your healthcare needs.
Learn about the importance of the Identification Card in Health Insurance. This card is essential for identifying members of a health care plan and must be presented during medical services.
Learn about utilization management in health insurance, a vital method for assessing the need for various medical services to ensure appropriate care and cost management.
Learn about the definition of an in-patient, an individual admitted to a hospital or healthcare facility as a patient in residence, in the context of general insurance.
Learn about hospital benefits in health insurance, which cover costs incurred during hospital visits, including room expenses and additional charges.
