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Point-of-Service (POS) |
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A type of managed-care plan that combines features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Most POS plans enable the insured to decide whether to go to a doctor contracted with the plan and pay a flat dollar copayment, or go to a doctor not contracted with the plan and pay an annual
deductible and coinsurance. |
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Preferred Provider Organization (PPO) |
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A combination of traditional fee-for-service and an HMO. When doctors and hospitals used are part of the PPO, the insurer covers a larger
part of medical bills. Using other doctors is allowed, but results in higher costs for the insured. |
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Pre-existing Condition |
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A health problem that existed or for which the insured received treatment before the date healthcare insurance became effective. Most
healthcare insurance policies have clauses that describe under what circumstances medical expenses related to pre-existing condition will be covered by the plan. |
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Premium |
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The payment, or regular periodic payments, that a policyholder makes to own an insurance policy. Healthcare plan premiums are often
expressed as a monthly premium payment. |
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Primary Care Physician or Doctor |
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Usually, the first contact for healthcare. Often, this is a family physician or internist, but some women use their gynecologist. A primary
care doctor monitors health and diagnoses and treats minor health problems, then may refer individuals to specialists if another level of care is needed. |
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Provider |
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Any person (doctor, nurse, dentist) or institution (hospital or clinic) that provides medical care. |