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Glossary of Medical and Insurance Terms

Glossary of Medical and Insurance Terms with simple definitions.
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A

Abdomen

Stomach, tummy, belly

Abrasion

Scrape, scratch or cut

Accessible

Available, on hand, understandable, usable (handicapped accessible), open, ready, within reach, can be used by.

Acquired Immune Deficeincy Syndrome (AIDS)

A disease that reduces your body's immune function and makes it hard for it to fight infections

Acute

Sudden start, short term, quick, new, recent, intense flare-up or serious pain

Acute Care

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.

Adverse Reaction

Bad or harmful reaction

Advocacy

Support, fighting on behalf of, arguing for support, help to get you something that you want or need.

Affordable

Low cost, at a good price, at a price you can pay

Aggregate Indemnity

The most you can receive for a covered service under all policies.

Allergic

The body's reaction to something like pollen, resulting in sneezing, sniffling, a rash, etc.

Allergy

Reaction to certain things such as food, or cloth, or pollen, itchy rash, hives, breathing problem.

Alternative Medicine

Treatment or care that is used instead of conventional or complementary medicine.

Ambulatory Care

Health care services that do not involve spending the night in the hospital. Also called "outpatient care."

Analgesic

Pain killer or pain reliever

Anaphylaxis

Shock, a sudden and severe allergic reaction, stop breathing, poisoning

Ancillary Services

Extra services, like lab work and physical therapy, which a patient gets in the hospital.

Annual Notice of Change (ANOC)

Important changes about how much your drugs/prescriptions will cost

Antibiotic

Drug, medicine, drug that fights bacteria, infection fighting medicine, or medicine that fights infections

Anti-Inflammatory

A drug to reduce swelling, something that reduces swelling and pain, aspirin, cortisone, a drug that brings down the swelling.

Arrhythmia

An irregular heartbeat, when heart doesn't have a steady beat

Arteriosclerosis

Hardening of the arteries.

Assignment (of Benefits)

When a member asks that benefits/amount the insurance company pays be paid directly to the doctor/hospital.

Asthma

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 Length of Stay

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

B

Beneficiary

A person who is eligible to receive benefits under a health plan.

Benefit

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.

Benefits Package

All the services covered by a health plan (or other plan).

Billed Charge

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.

Biopsy

Sample of tissue taken from part of the body for further study.

Blood Glucose

Blood sugar

BMI (Body Mass Index)

A measure of body fat based on height and weight or using your height and weight to determine if you are overweight

C

Cafeteria Plan

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.

Cardiologist

Heart doctor

Cardiovascular

Heart and/or blood vessel

Care Coordination/Case Management

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.

Caregivers

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.

Case Management

A service to help patients get the health care they need.

Catastrophic Health Insurance

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.

Centers for Medicare and Medicaid Services (CMS)

The federal agency that controls Medicare and Medicaid. CMS is part of the Department of Health and Human Services.

Certificate of Coverage

A description of the benefits included in an person's plan.

Chemotherapy

Drugs to treat cancer.

Cholesterol: HDL Cholesterol and LDL Cholesterol

Types of fat found in the blood; HDL is good fat, LDL is bad fat.

Chronic

Long term, long lasting, lifelong, constant, never ending, never goes away, happens again and again.

Chronic Care

Health care for people with constant, long-term health problems

Chronic Disease

A disease that is long term, long lasting or lifelong, constant, never ending, never goes away, will not improve.

Claim

A request that your health plan pay for a health service. Either you or your provider files the claim.

Clinical

Work, studies, a medical setting that involves patients (related to) medical care.

Clinicians

Health professionals who care for patients including physicians, nurses, social workers, pharmacists, physician assistants, dieticians, physical therapists, speech therapists, and occupational therapists.

COBRA

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.

Co-insurance

The amount of money you owe for health services after you have paid the deductible.

Collaborate

Work together, team up, help each other.

Colonoscopy

An exam of the inside of the large intestine that uses a flexible tube with a lens at the end.

Communicable

Catching, can be spread, can be passed to other people, can make other people sick

Complementary Medicine

Treatment or care that is used together with conventional medicine.

Comprehensive

Complete, covers everything important, thorough, all, total, the whole, full, major, large

Congenital

Born with, present at birth

Congestive Heart Failure

When the heart isn't pumping hard enough.

Concent

Accept, allow, permit, let

Consumer-Driven Health Plan

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.

Contagious

Catching, spreading, able to make others sick, spreadable, sick

Contaminant

Pollutant, poison, harmful ingredient, harmful chemical

Continuation of Care

Being able to get care from your doctor even if he or she no longer works with your health plan.

Contracted Group

The group of doctors who work with your health plan.

Coordinate

Make all parts of your care work together; talk with other doctors, nurses, or other health care providers.

Coordination or Management Care

Coordinating your care, making sure you get the care you need, overseeing your care.

Copayment ("Copay")

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.

COPD (Chronic Obstructive Pulmonary Disease)

Emphysema, a lung disease that makes breathing hard.

Coronary Heart Disease

Heart disease

Coverage

Health care costs that are paid for by your health insurance or by the government.

Covered Service or Expense

That portion of a medical, dental or vision expense that your benefit plan has agreed to pay for or reimburse.

D

Deductible

The amount of money you pay before your insurance starts to pay.

Dementia

Memory loss that gets worse over time; Alzheimer's.

Dependent

A child, disabled adult child, or spouse covered by an employee's health plan.

Dermatologist

Skin doctor

Diabetes

Elevated sugar in the blood.

Diagnosis

Find the problem or condition, finding out the cause of an illness, condition or disease, medical answer.

Disability

A physical, mental or social condition that limits a person's ability to function in important or basic life activities.

Disclose

Show, tell, share, give

Disease

Illness, sickness

Disease Management

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.

Dosage

Amount, how much medicine to take

Drug Formulary

List of medicines a health plan will pay for.

E

Effective

Works well, good, strong

Elective

Service or treatment that you and your doctor plan ahead of time and that is not always medically necessary.

Electronic Medical Record

A computer record of a patient's health and the care he or she has received; record

Eligibility

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.

Eligible Service or Expense

A medical, dental or vision expense your benefit plan says can be paid for or reimbursed

Emergency

A health problem that starts suddenly and needs care right away, something that cannot wait, accident, crisis

Employee Assistance Programs (EAPs)

Programs designed to help employees with workplace and personal problems.

Enrolee

An eligible person who is covered/insured by a health plan.

EOB

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.

Evidence-Based Medicine (EBM)

Medical treatments that have been shown to have the best results.

Evidence of Coverage (EOC)

A summary that tells you what your health plan will and will not pay for.

Exclusions

Services not covered by the plan, services your insurance does not pay for.

Expertise

Ability, knowledge, skill, know-how, training

F

Family Caregiver

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.

Fee-for-Service (FFS)

A way of paying for health care. Under this system, providers are paid for each service they provide.

Flexible Spending Account (FSA)

A benefit plan that lets workers put pre-tax dollars in special accounts to help pay medical costs, child care, and other health services.

Formulary

A list of drugs/medicines/prescriptions that are paid for by your insurance company.

Formulary Drugs

A list of the prescriptions covered by your HMO.

G

Gap In Coverage

A time period when you are without health coverage.

Gatekeeper

Usually your main doctor. The "gatekeeper" decides which services you can get and which other doctors you can see.

General Practice

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.

Generic Drugs

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

Guaranteed Issue

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.

H

Health Care Professionals

People who care for you; doctors and nurses.

Health Care Provider

Members of the treatment team; can be medical, holistic health and behavioral professionals and other appropriately-trained individuals.

Health Insurance

A system which you pay a monthly amount (called a premium) in exchange for help paying health care costs.

HIPPA (Health Insurance Portability and Accountability Act)

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.

HMO (Health Maintenance Organization)

A kind of health insurance plan. HMO members usually must get services through doctors, labs, and hospitals that contract or work with the HMO.

Health Plan

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 Reimbursement Accounts (HRAs)

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 Savings Accounts (HSAs)

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.

Heart Failure

A condition in which the heart can't adequately pump blood throughout the body.

Hematoma

A collection of blood under the skin or in the body that is typically caused by a broken blood vessel.

High-Deductible Health Plan

A type of health plan defined by the IRS that lets people save money tax-free in health savings accounts.

Home Health Care

Skilled nurses and trained aides who provide nursing services and related care in your home.

Hypertension

High blood pressure

I

Immunization

Getting a vaccine (shot).

Immunize

To protect against disease, usually by a shot.  

Indemnity Health Plan

A fee-for-service health plan that's not in a network.  

Influenza

Flu

Inpatient

When a person is admitted/ goes into a hospital or other health facility.  

Instructions

Steps to follow; how-to guides; directions; plan

L

Life-Limiting Illness/ Terminal Illness

A severe illness that is expected to get worse and to end the life of the patient.

Living Will

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.

Long-Term Care Insurance

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.

M

Managed Care Organization (MCO)

An insurance organization that arranges benefits through managed care. An HMO is a type of MCO.

Medicaid

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.

Medicare

A federal insurance program for people 65 and older and for people under 65 when they are disabled/not able to do certain things.

Medication

Medicine; drugs; pills; syrup

Member

Person who is enrolled in a health plan.

Mental Health Provider

Person or place licensed to provide mental health services.

N

Network

A group of doctors, hospitals and other health care providers that have contracts with an insurance company to provide care at special rates.  

Non-Participating Provider

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.  

Nurse Practitioner

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.

Nutrition

Food; meal; diet; healthy food

O

Open Enrollment Period

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.

Osteoporosis

Brittle bones

Out-of-Network

Services provided by a non-participating provider

Out-of-Pocket Maximum (Limit)

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.

Outpatient

Someone who receives health services or treatments, but does not stay overnight at a hospital; when the patient does not stay in the hospital.

P

Palliative Care

Any form of care designed to relieve pain or side effects of treatment and improve quality of life.

Participating (providers)

Doctors, clinics, etc. that have joined [health plan] or that serve [health plan] members.

Pharmacist

The druggist; person who sells your medicine; drug dispenser

Physical Examination

Checkup; doctor appointment

Physical Therapist

Someone who treats pain and weakness by exercise.

Physician

Doctor

Physician's Assistant (PA)

A health professional who is not a doctor but who provides care to patients. A doctor supervises a PA.

Pneumonia

Lung infection

Point-of-Service Plan (POS)

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.

Pre-Authorization

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.

Pre-Existing Condition (PEC)

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.

Preferred Provider Organization (PPO)

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.

Premium

Money you pay each month; monthly payment to the insurance company/health plan

Pre-natal care

Health care services for women while they are pregnant.

Prescription (Rx)

Medicine; drugs; the doctor's order for your medication.

Preventive care Care

Health care services that help prevent disease. Flu shots and Pap smears are examples of preventive care.

Primary Care Provider (PCP)

Your main doctor, who provides most of your care. A PCP also coordinates your other health care services and treatments.

Procedure

Operation; something done to treat your problem; way; rule; program; style; how-to; course of action

Protected Health Information

Personal medical information that is protected by the law.

Provider

Any person, clinic or group that gives a member health care services.

Q

Qualified

Suited; capable

Qualified Beneficiaries

Your family; family members on your insurance plan

Quality of Care

Assessment of patient outcomes, which may include review for use of recommended guidelines and evidence-based practices as basis of plan for care.

R

Referral

Ask you to see another doctor; get a second opinion

Register

Sign up; sign in

Risk

Chance; in danger of

S

Screening

To test for somthing

Seizure

Fit of uncontrolled movements.

Severe

Strong; serious; harmful; dangerous; very bad

Short-Term Disability

An injury or illness that keeps a person from working for a short time. Different insurance companies define "short-term" differently.

SIDS (Sudden Infant Dealth Syndrome)

Cot or crib death. Sudden death of an infant less than age 1 year with no cause or reason.

Social Worker

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.

Specialist

A doctor who has extra training in a special field. For example, some doctors are specialists in children's health or cancer treatment.

Stabilization

Actions that prevent a physical health condition or disease from getting worse. This term should not be used in relation to mental health issues.

Stress

Physical, mental or emotional tension or strain.

Support

Help with your needs- for money, friendship or care.

Surgery

Operation

Symptoms

Problems, signs, or warnings of illness.

Syndrome

Illness; sickness; set of signs that often go together

T

Transitions of Care

Process of a patient leaving one care setting and moving to another setting or to the patient's home.

Treat

Give; care; take care of; cure; heal

Treatment

Cure; therapy; remedy; medicine; diet; action

U

Unavailable

Not able to get or find; cannot get; none

Urgent Care

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.

Usual, Customary and Reasonable Charge (UCR)

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)

V

Vaccine

Shot; flu shot; medicine

W

Waiting Period

A period of time that must pass before you are covered by insurance.

Warning Sign

Signals to alert you something may be wrong.

Wellness

Good mental and physical health; feeling good; well-being

Whooping Cough

Disease of the lungs that is very easily spread to others.

Workers' Compensation Coverage

A state program that requires employers to pay some wages and costs for employees who have work-related injuries or disabilities.