Glossary of Medical and Insurance Terms
Glossary of Medical and Insurance Terms with simple definitions.
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Stomach, tummy, belly
Scrape, scratch or cut
Available, on hand, understandable, usable (handicapped accessible), open, ready, within reach, can be used by.
A disease that reduces your body's immune function and makes it hard for it to fight infections
Sudden start, short term, quick, new, recent, intense flare-up or serious pain
Medical care for people who need care right away but not for a long period of time. "Acute-care facilities" are hospitals that mainly treat people with short-term health problems.
Bad or harmful reaction
Support, fighting on behalf of, arguing for support, help to get you something that you want or need.
Low cost, at a good price, at a price you can pay
The most you can receive for a covered service under all policies.
The body's reaction to something like pollen, resulting in sneezing, sniffling, a rash, etc.
Reaction to certain things such as food, or cloth, or pollen, itchy rash, hives, breathing problem.
Treatment or care that is used instead of conventional or complementary medicine.
Health care services that do not involve spending the night in the hospital. Also called "outpatient care."
Pain killer or pain reliever
Shock, a sudden and severe allergic reaction, stop breathing, poisoning
Extra services, like lab work and physical therapy, which a patient gets in the hospital.
Important changes about how much your drugs/prescriptions will cost
Drug, medicine, drug that fights bacteria, infection fighting medicine, or medicine that fights infections
A drug to reduce swelling, something that reduces swelling and pain, aspirin, cortisone, a drug that brings down the swelling.
An irregular heartbeat, when heart doesn't have a steady beat
Hardening of the arteries.
When a member asks that benefits/amount the insurance company pays be paid directly to the doctor/hospital.
Breathing disease, long-term disease of swelling of the airways of the lungs; lung disease in which you have trouble breathing; disease of lungs or respiratory system.
Average number of days someone stays in the hospital.
Just Plain Clear: English and Spanish Glossary
UnitedHealth Group created the Just Plain Clear glossary. You'll find thousands of terms defined in plain, clear language to help you make informed decisions. We hope you use Just Plain Clear in the best of health
A person who is eligible to receive benefits under a health plan.
Help, useful to, an advantage, a gathering of people to raise funds, the amount of money a health plan/insurance company will pay for your treatment or health care services.
All the services covered by a health plan (or other plan).
The total charges billed by health care service providers. It includes both hospital and doctor charges. It shows the gross billed or retail price of services offered by the health care facility and it does not represent the amount paid by the beneficiary or the amount collected by the provider.
Sample of tissue taken from part of the body for further study.
A measure of body fat based on height and weight or using your height and weight to determine if you are overweight
A benefits plan offered by some employers that generally allows employees to choose among certain benefit options such as medical and dental insurance to best suit their needs. The benefits are usually paid for with pre-tax dollars.
Heart and/or blood vessel
A process that usually includes assessing a patient's needs and goals; creating and carrying out a plan of care; and evaluating the patient's response to the plan of care.
A person who provides needed services to the patient to assist in their comfort and help them manage their activities of daily living; may include personal care, carrying out medical procedures, managing a household, and interacting with the health care and social service systems on another's behalf.
A service to help patients get the health care they need.
Health insurance designed to protect you against financial hardship due to unexpected medical expenses. Catastrophic health insurance often has a high deductible. This means that you must pay a large amount before insurance starts to pay.
The federal agency that controls Medicare and Medicaid. CMS is part of the Department of Health and Human Services.
A description of the benefits included in an person's plan.
Drugs to treat cancer.
Types of fat found in the blood; HDL is good fat, LDL is bad fat.
Long term, long lasting, lifelong, constant, never ending, never goes away, happens again and again.
Health care for people with constant, long-term health problems
A disease that is long term, long lasting or lifelong, constant, never ending, never goes away, will not improve.
A request that your health plan pay for a health service. Either you or your provider files the claim.
Work, studies, a medical setting that involves patients (related to) medical care.
Health professionals who care for patients including physicians, nurses, social workers, pharmacists, physician assistants, dieticians, physical therapists, speech therapists, and occupational therapists.
Acronym for Consolidated Omnibus Budget Reconciliation Act. Federal law that requires employers to offer continued health insurance coverage to certain employees and their dependents whose group health insurance coverage has been terminated.
The amount of money you owe for health services after you have paid the deductible.
Work together, team up, help each other.
An exam of the inside of the large intestine that uses a flexible tube with a lens at the end.
Catching, can be spread, can be passed to other people, can make other people sick
Treatment or care that is used together with conventional medicine.
Complete, covers everything important, thorough, all, total, the whole, full, major, large
Born with, present at birth
When the heart isn't pumping hard enough.
Accept, allow, permit, let
A kind of health plan that asks employees to pay for some of their medical, dental and vision costs out of a Health Reimbursement Account, Health Savings Account or out of their own pockets, encouraging people to think about how they spend money on health care.
Catching, spreading, able to make others sick, spreadable, sick
Pollutant, poison, harmful ingredient, harmful chemical
Being able to get care from your doctor even if he or she no longer works with your health plan.
The group of doctors who work with your health plan.
Make all parts of your care work together; talk with other doctors, nurses, or other health care providers.
Coordinating your care, making sure you get the care you need, overseeing your care.
Fee paid at time of visit for a doctor's appointment, hospital stay or other service; the money that you have to pay each time you see a doctor or fill a prescription.
Emphysema, a lung disease that makes breathing hard.
Health care costs that are paid for by your health insurance or by the government.
That portion of a medical, dental or vision expense that your benefit plan has agreed to pay for or reimburse.
The amount of money you pay before your insurance starts to pay.
Memory loss that gets worse over time; Alzheimer's.
A child, disabled adult child, or spouse covered by an employee's health plan.
Elevated sugar in the blood.
Find the problem or condition, finding out the cause of an illness, condition or disease, medical answer.
A physical, mental or social condition that limits a person's ability to function in important or basic life activities.
Show, tell, share, give
Programs for people who have chronic diseases, like asthma or diabetes. These programs teach you to live in healthy ways, take medications the right way, and more.
Amount, how much medicine to take
List of medicines a health plan will pay for.
Works well, good, strong
Service or treatment that you and your doctor plan ahead of time and that is not always medically necessary.
A computer record of a patient's health and the care he or she has received; record
Language in a plan that says who can be covered. If you are not covered, you are ineligible and cannot have the insurance company pay for the service.
A medical, dental or vision expense your benefit plan says can be paid for or reimbursed
A health problem that starts suddenly and needs care right away, something that cannot wait, accident, crisis
Programs designed to help employees with workplace and personal problems.
An eligible person who is covered/insured by a health plan.
Explanation of Benefits. The EOB is a statement provided to the individual or health care provider. The EOB explains the benefits provided, the reimbursement amounts allowed, deductibles, coinsurance, or other adjustments taken, and the net amount paid.
Medical treatments that have been shown to have the best results.
A summary that tells you what your health plan will and will not pay for.
Services not covered by the plan, services your insurance does not pay for.
Ability, knowledge, skill, know-how, training
A person who provides physical, emotional, or financial assistance to a relative or friend who is ill, elderly, or living with a disability; person who helps take care of another person.
A way of paying for health care. Under this system, providers are paid for each service they provide.
A benefit plan that lets workers put pre-tax dollars in special accounts to help pay medical costs, child care, and other health services.
A list of drugs/medicines/prescriptions that are paid for by your insurance company.
A list of the prescriptions covered by your HMO.
A time period when you are without health coverage.
Usually your main doctor. The "gatekeeper" decides which services you can get and which other doctors you can see.
Doctors who offer a wide range of health care services to patients. These doctors do not have extra training in one special area of medicine, such as surgery.
Copy of a drug that is the same as a brand-name drug in how it is taken, safety, strength, quality, performance, and intended use
A rule that says a health plan must cover anyone who applies for coverage. The rule also says that the health plan must cover members as long as they pay the plan premium.
People who care for you; doctors and nurses.
Members of the treatment team; can be medical, holistic health and behavioral professionals and other appropriately-trained individuals.
A system which you pay a monthly amount (called a premium) in exchange for help paying health care costs.
Under this federal law, group health plans can't deny coverage based solely on an individual's health status. This law also gives employees who change or lose their jobs better access to health coverage, makes sure there's renewability and availability to certain employees, limits exclusions for pre-existing conditions, and provides privacy and security standards for an individual's health information.
A kind of health insurance plan. HMO members usually must get services through doctors, labs, and hospitals that contract or work with the HMO.
A group that covers health care services. HMO's and self-funded plans are examples of health plans.
Review plans and choose a plan that is right for you.
Health care accounts that employers fund for covered workers or retired persons. The IRS does not tax this money and allows any money left in these accounts at the end of the year to roll over to be used the next year.
Health care bank accounts that let people put money aside tax free to pay for medical, dental and vision costs. The IRS limits who can open and put money into an HSA. Money in an HSA can stay in the account until it is used.
A condition in which the heart can't adequately pump blood throughout the body.
A collection of blood under the skin or in the body that is typically caused by a broken blood vessel.
A type of health plan defined by the IRS that lets people save money tax-free in health savings accounts.
Skilled nurses and trained aides who provide nursing services and related care in your home.
High blood pressure
Getting a vaccine (shot).
To protect against disease, usually by a shot.
A fee-for-service health plan that's not in a network.
When a person is admitted/ goes into a hospital or other health facility.
Steps to follow; how-to guides; directions; plan
A severe illness that is expected to get worse and to end the life of the patient.
A document that records the type of care a person wants (or does not want) to receive in case of serious illness or at the end of their life. Living wills do not address decisions regarding property or other valuables.
Insurance that may cover the cost of personal care and other services given at home, in a nursing home, or in other places when the insured person has a chronic disability or disability.
An insurance organization that arranges benefits through managed care. An HMO is a type of MCO.
A federal program administered and operated individually by participating state and territorial governments that provides medical benefits to eligible low-income people needing health care. The program's costs are shared by the federal and state governments.
A federal insurance program for people 65 and older and for people under 65 when they are disabled/not able to do certain things.
Medicine; drugs; pills; syrup
Person who is enrolled in a health plan.
Person or place licensed to provide mental health services.
A group of doctors, hospitals and other health care providers that have contracts with an insurance company to provide care at special rates.
A provider who does not contract with your health plan. Also known as an out-of-network or non-network provider. Usually, you must pay your own health care costs to see a non-participating provider.
A registered nurse (RN) who has speical training and experience that allows him or her to provide some care that doctors provide. In many states Nurse Practicioners may be able to prescribe medications.
Food; meal; diet; healthy food
The time when you can re-enroll in the health plan you are already in or choose to enroll in another health plan. You can usually do this without waiting periods or proof of insurance. Usually takes place in the fall.
- More about Open Enrollment
Services provided by a non-participating provider
The most you have to pay for health services every year. Once you have paid this amount, your insurance company usually pays 100 percent of your health care costs, subject to any policy limitations.
Someone who receives health services or treatments, but does not stay overnight at a hospital; when the patient does not stay in the hospital.
Any form of care designed to relieve pain or side effects of treatment and improve quality of life.
Doctors, clinics, etc. that have joined [health plan] or that serve [health plan] members.
The druggist; person who sells your medicine; drug dispenser
Checkup; doctor appointment
Someone who treats pain and weakness by exercise.
A health professional who is not a doctor but who provides care to patients. A doctor supervises a PA.
A health benefit plan that allows the covered person to choose to receive service from a participating or non-participating physician or other health care provider, with different benefit levels associated with the use of participating physicians or other health care providers.
The process of getting approval from your health plan before you get services. This process lets a provider know if the health plan will cover a needed service.
An injury or sickness that was diagnosed or treated, or for which drugs were prescribed or taken, within a specified period of time immediately preceding the covered person's effective date of coverage. Pre-existing conditions may not be covered for some specified amount of time as defined in the plan.
An organization where providers are under contract to provide care at a discounted or negotiated rate. Usually, the benefit contract provides much better benefits and lower costs for services received from preferred physicians and other health care providers, encouraging covered persons to use these physicians and providers.
Money you pay each month; monthly payment to the insurance company/health plan
Health care services for women while they are pregnant.
Medicine; drugs; the doctor's order for your medication.
Health care services that help prevent disease. Flu shots and Pap smears are examples of preventive care.
Your main doctor, who provides most of your care. A PCP also coordinates your other health care services and treatments.
Operation; something done to treat your problem; way; rule; program; style; how-to; course of action
Personal medical information that is protected by the law.
Any person, clinic or group that gives a member health care services.
Your family; family members on your insurance plan
Assessment of patient outcomes, which may include review for use of recommended guidelines and evidence-based practices as basis of plan for care.
Ask you to see another doctor; get a second opinion
Sign up; sign in
Chance; in danger of
To test for somthing
Fit of uncontrolled movements.
Strong; serious; harmful; dangerous; very bad
An injury or illness that keeps a person from working for a short time. Different insurance companies define "short-term" differently.
Cot or crib death. Sudden death of an infant less than age 1 year with no cause or reason.
A professional who can identify resources to help individuals, families, groups and communities cope with social and emotional factors affecting their health and well-being.
A doctor who has extra training in a special field. For example, some doctors are specialists in children's health or cancer treatment.
Actions that prevent a physical health condition or disease from getting worse. This term should not be used in relation to mental health issues.
Physical, mental or emotional tension or strain.
Help with your needs- for money, friendship or care.
Problems, signs, or warnings of illness.
Illness; sickness; set of signs that often go together
Process of a patient leaving one care setting and moving to another setting or to the patient's home.
Give; care; take care of; cure; heal
Cure; therapy; remedy; medicine; diet; action
Not able to get or find; cannot get; none
Urgent care is care for health problems that are not emergencies but need attention quickly. A sprained ankle is a health problem that would require urgent care.
The amount of money that it usually costs to pay for a specific health care service based on where you live. Health insurance companies use this amount to help determine how much should be paid to a health care provider; also called Reasonable & Customary (R&C)
Shot; flu shot; medicine
A period of time that must pass before you are covered by insurance.
Signals to alert you something may be wrong.
Good mental and physical health; feeling good; well-being
Disease of the lungs that is very easily spread to others.
A state program that requires employers to pay some wages and costs for employees who have work-related injuries or disabilities.