Page 37 - Allegacy 2017 booklet 8.5x11

Allegacy Benefit Solutions Page 37

Glossary of Terms

Allowable Amount-the charge that the carrier determines as reasonable for
covered services provided to a member.

Benefit Period-the period of time during which charges for covered services
provided to a member must be incurred in order to be eligible for payment from
the carrier.

Coinsurance-the sharing of charges by the insurance company and the
member for covered services received by a member.

Coinsurance maximum-the maximum amount of coinsurance that a member is
obligated to pay for covered services per benefit period.

Conversion-the option to convert a group policy to an individual policy upon
termination of employment without giving information about your health.

Copay-the fixed-dollar amount which is due and payable by the member at the
time a covered service is provided.

Deductible-the specified dollar amount for certain covered services that the
member must incur before benefits are payable for the remaining covered
services. The deductible does not include copays.

Evidence of insurability-the ability to apply for and receive coverage based on
the guidelines of the carrier, may involve answering health questions and/or
medical exam.

Generic-a drug name not protected by a trademark.

In-Network-Providers and facilities that are contracted with a carrier to provide
services to members of that carrier’s plan(s) at a cost determined by the con-
tract, usually a lesser amount than patients without insurance coverage.