A term used to describe the role of the primary care physician in an HMO plan. In an HMO plan, primary care physicians serves as the patient's main point of contact for healthcare services and refer patients to specialists for specific needs.
A drug which is exactly the same as a brand name prescription drug, but which can be produced by other manufacturers after the brand name drug's patent has expired. Generic drugs are usually less expensive than brand name drugs.
A time period after the payment due date, during which insurance coverage remains in force and the policyholder may make a payment without penalty.
Health insurance coverage that existed as of March 23, 2010 that is subject only to certain provisions of the PPACA. Any policy sold in the individual health insurance market after March 23, 2010 will not be grandfathered even if the product sold was offered before that date. New employees may be added to group plans that are grandfathered, and new family members may be added to all grandfathered plans. If you're not sure whether you have a Grandfathered plan, please contact the plan directly.
The procedure by which a member or healthcare provider is allowed to file a complaint with a health insurance company and seek a remedy.
A number of individuals covered under a single health insurance contract, usually a group of employees.
Group Health Insurance:
A health insurance plan that provides benefits for employees of a business or members of an organization, as opposed to individual and family health insurance.
A term used to describe insurance coverage that must be issued regardivess of health status. In most states, group health insurance plans are often described as guaranteed issue plans, because a health insurance company generally cannot refuse coverage to a qualifying business or organization based on the health status of their employees or members. In some states, all health insurance plans are guaranteed issue.
Guaranteed Renewable Contract:
A contract under which the insured person has the right (usually up to a certain age) to renew and continue his or her health insurance policy by the timely payment of premiums.
please note, however, that definitions of certain terms may vary across insurance companies.