Accident:
An unexpected event that causes injury.
Basic Medical Plan:
Insurance coverage that pays agreed-on medical expenses up to a relatively low maximum. For example, an insurance maximum may be $50,000 lifetime benefit for each injury or sickness.
Benefits:
The money the insurance company pays the health care provider for medical services to you if you become ill or injured.
Claim:
A request by you for payment by the insurance company of medical expenses that are covered under the insurance policy. The provider of a medical service will usually file a claim for you.
Co-insurance:
The amount (typically a percentage) you are obligated to pay for covered medical services after you’ve satisfied any co-payment or deductible required by your health insurance plan.
Co-payment:
The set or fixed-dollar amount you are required to pay each time a particular medical service is used. A co-payment for services may be $10 per visit.
Coverage:
The conditions for which the insurance company will pay.
Deductible:
The cumulative amount that you must pay annually before benefits will be paid by the insurance company. If the insurance policy indicates a "$250 deductible," the insurance company pays as agreed after you pay the first $250.
Dependents:
Your spouse and children.
Emergency:
A severe medical condition which may include pain, loss of breathing or consciousness, heart attack, stroke, poisoning, convulsions or severe bleeding.
Exclusions:
Conditions for which the insurance company will not pay; for example, cosmetic procedures are exclusions.
Explanation of Benefits (EOB):
The statement you receive from the insurance company showing the services, amounts paid by the plan and total for which you are being billed.
Health Insurance Policy (coverage, plan):
Insurance to cover the costs or losses incurred if an insured person falls ill.
Identification Card:
A card given to you that identifies you as being eligible for benefits. The card must be presented when seeking treatment.
Insurance:
A system under which individuals, businesses and other organizations, in exchange for a premium, are promised payment for losses resulting from certain dangers as specified in a contract.
Insurance Company:
An organization licensed to operate as an insurer.
Insurance Policy:
The legal document issued by the company to the policyholder (Purdue) which outlines the terms and conditions of the insurance; also called a "contract."
Insured:
A person or organization covered by an insurance policy.
Major Medical:
A plan that provides much broader coverage than the basic medical plan up to a high limit. You may increase your coverage by paying an additional amount more than your basic premium.
Network:
A group of medical providers that are contracted with a specific insurance company for highest payment levels.
OSU Health Fee:
Charged to all students, provides on-campus health clinic with clinician visits covered as part of the health fee, violence prevention programs, health promotion and education to the campus community.
Out-of-network care:
Healthcare rendered to a patient outside of the health insurance company's network of preferred providers. In many cases, the health insurance company will not pay for these services.
Out-of-Pocket Costs:
The total you pay out of your pocket for a policy year. These costs include the deductible, co-insurance and amounts considered by the insurance company to be above the "Usual and Customary charges."
Pharmacy:
A business where drugs approved by a doctor are legally sold.
Pre-existing Condition:
A medical condition that required treatment during a fixed period of time, usually 3 or 6 months, before you purchased your insurance policy.
Premium:
The price you pay for your insurance policy.
Stop Loss:
See "Out-of-Pocket Costs."
Usual and Customary Charges:
(Also called "Reasonable and Customary Charges") The routine charge for a medical service by similar professional medical providers in the same geographical area. You may pay an amount above the Usual and Customary charge if a provider charges more than other providers for the same service.