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术语表

Click on a letter to jump to the glossary items beginning with that letter.

A

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加速死亡抚恤金(非洲开发银行)

这可以帮助那些患有致命疾病的人. The member or spouse can get some life insurance benefits as an early payment.

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意外死亡和肢解(公元&D)

This benefit can be paid in two ways. It can be paid to the insured person after an accidental injury. Or it can be paid to someone else after the death of an insured person.

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Accidental death and personal loss (AD&PL)或广告&D超®

这一福利涵盖了与AD相同的损失&D. 它还为其他意想不到的事件买单. Such events could cause loss of sight, speech or hearing. 在死亡情况下,补助金可用于教育、儿童保育和其他服务.

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Accountable care organization (ACO)

It is a group of doctors, hospitals and other health care providers. 他们一起工作以协调对病人的护理. They are responsible for:

 

  • Improving care quality and efficiency
  • 实现更好的健康成果的目标
  • 降低总体医疗成本
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认证

This is proof that a health plan or hospital meets certain standards. An outside group decides this through an official review.

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Active full-time employee

This is a person who works a normal workweek for an employer. 雇员的工作时间必须至少达到保险计划的工作时间.

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ada

也被称为美国残疾人法案. This law protects the rights of people with disabilities. It helps prevent them from being treated unfairly on the job.

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adb

也被称为死亡抚恤金. 这可以帮助那些患有致命疾病的人. The member or spouse can get some life insurance benefits as an early payment.

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AD&D

也被称为意外死亡和肢解. This benefit can be paid in two ways. It can be paid to the insured person after an accidental injury. Or, it can be paid to someone else after the death of an insured person.

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adea

也被称为年龄歧视就业法案. 这是一个U.S. law. It protects people against unfair treatment in the workplace due to age.

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裁定

这是健康计划决定他们将为某些费用支付多少的方式.

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调整pre-disability收益

如果你因病或受伤而不能工作,长期残疾计划可以为你提供一种收入来源. 这可以帮助你保持残疾前收入的一定比例. Adjustments are made over time to help protect against inflation. Example: A disability plan pays 60% of your salary. You earned $SOK before you become disabled at age 40. 没有调整你的收入, 到你60岁时,通货膨胀会大大降低你的购买力.

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AD&PL

也被称为 accidental death and personal loss coverage. 这一福利涵盖了与AD相同的损失&D. 它还为其他意想不到的事件买单. Such events could cause loss of sight, speech or hearing. 在死亡情况下,补助金可用于教育、儿童保育和其他服务.

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预先指令

这份法律文件告诉你的医生你想要或不想要什么样的治疗. It will be used if you are too sick to make medical decisions on your own. 它有时也被称为生前遗嘱.

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正规的电竞竞猜软件医疗应用

正规的电竞竞猜软件健康® 应用程序通过提供易于导航的信息和无缝连接你的护理,帮助你从你的健康计划和福利中获得最大的好处. 了解更多信息并下载aetna Health®应用程序 在App Store和谷歌Play上.

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正规的电竞竞猜软件HealthFund®

This is the name used for aetna's consumer-directed health products. 每个人都有不同类型的基金来帮助成员支付他们的护理费用. These funds are health reimbursement arrangement (hra), 健康储蓄帐户(hsa), retiree reimbursement account (rra), flexible spending account (fsa) and first dollar plan.

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aetna member website

Take charge of your health plan with the aetna member website. 获取所有你需要的计划信息,并找到帮助你管理福利的工具. Register and log in today

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Affordable Care Act (ACA)

The comprehensive health care reform law enacted in March 2010.

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《电竞竞猜比较正规的》

这是一个U.S. law. It protects people against unfair treatment in the workplace due to age.

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酒精和药物限制或限制

This limits the length of time benefits will be paid. It applies to treatment for disabilities due to alcohol or drug abuse.

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Allowable expense(s)

This is the part of a bill that is eligible to be paid under your health plan.

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允许数量

你的健康计划将支付的金额的限制. Also called the recognized charge. If you choose to go out of network, 你的供应商可能不会接受这一金额作为全部付款,可能会要求你支付其余的费用. This is in addition to your plan's required copays and deductibles.

 

查看您的计划文件以了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外保健,以及正规的电竞竞猜软件如何计算允许的金额. Or call 会员服务 at the phone number listed on your aetna 身份证.

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门诊

也被称为门诊治疗. 这是一个人在诊所、急诊室、医院或手术中心得到的护理. The person gets the care and goes home. There is no overnight stay.

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眼科手术

也被称为 an outpatient procedure. Some procedures can be done in a hospital, surgery center or doctor's office. The person gets it done and goes home. There is no overnight stay.

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Americans with Disabilities Act (ada)

This law protects the rights of people with disabilities. It helps prevent them from being treated unfairly on the job.

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辅助服务

These are services provided to support your health care. 一些例子包括x光或实验室测试.

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年度协调选举期

This is a time when you can make changes to your 医疗保险 plan.

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任何职业

This is any type of job for which a person is qualified. A person can do the job because of schooling, training or experience.

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上诉程序

这个过程可以让你要求对被你的健康计划拒绝的索赔进行审查.

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授权*

这是一个重要的过程. It is approval a person gets for care before receiving care. This helps people know if the care is covered by a health plan. 人们应该检查他们的计划,看看什么样的服务需要这个批准.

 

This can also be called:

 

  • Precertification
  • 认证
  • 之前的授权

*在德克萨斯州, 这一批准被称为服役前使用审查,而不是根据德州法律定义的核查.

B

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平衡账单

医生或医院有时会这样做. 他们向病人收费,以弥补他们通常的费用和他们从健康计划中支付的金额之间的差额. Doctors and hospitals that work with aetna will not do this.

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减肥手术

This is weight-loss surgery. 这是为那些没有通过节食和锻炼减肥的超重的人准备的. Doctors perform two types. 一个可以使胃变小. 另一部分绕过肠道.

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平衡账单 (医疗保险)

不收取医疗保险批准的费用的医生或医院有时会这样做. 他们向病人收取批准的费用和医疗保险允许的最高金额之间的差额. The top amount is 15 percent more than the approved fee. Doctors and hospitals that work with aetna will not do this.

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行为健康

这也被称为心理健康. It describes a person's state of mind. 抑郁、饮食失调和药物滥用都属于这个术语.

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受益人

This is the person you choose to receive your assets if you die. 它可以是你选择的人在你死后从人寿保险中获得赔偿. It also applies to other types of insurance, such as AD&D.

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受益人 (医疗保险)

This is someone who has a health plan under 医疗保险.

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好处

This refers to medical services covered by your health plan. This word is also used to describe your health plan in general. 它也可以指在计划下收到的付款.

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效益持续时间

This is the length of time that benefits will be paid. It applies to workers who are out on short-term or long-term disability.

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受益最大的

This is the maximum amount that may be paid under a benefit plan. 利益最大化有几种类型.

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受益期

为计划成员提供医疗保险的连续天数.

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委员会认证

这描述了符合国家知识标准的卫生保健从业人员, 专业领域的技能和经验. 这些从业人员包括医生、医师助理、牙医、药剂师和护士.

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名牌药物

A drug sold by a drug company under a specific name or trademark. 名牌药物s may be available by prescription or over the counter.

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broker

保险经纪人也被称为代理人. They are licensed by states as agents, brokers or insurance producers. Insurance brokers help a person or business buy an insurance plan. The insurance plan can be bought through a health insurance exchange. 或者可以直接从保险公司购买. brokers represent the person or business buying insurance. However, they are usually paid by a commission from the insurer.

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青铜健康计划

See "Health plan categories."

C

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均摊

这是医生和医院从健康计划中获得的固定数额的钱,用于服务计划成员. They get this amount no matter how many patients they see.

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病例管理

This is the way health plans help people with complex care needs. Case managers help coordinate care to help people improve their health.

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Centers for 医疗保险 & 医疗补助服务 (cms)

This is a federal agency. 它运行着医疗保险计划. It also works with states to run the 医疗补助计划 program.

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Certificate of coverage

This details the benefits provided by your health plan. 它列出了覆盖的内容和未覆盖的内容. You will get this document after you sign up for a plan.

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认证*

这是一个重要的过程. It is approval a person gets for care before receiving the care. This helps people know if the care is covered by a health plan. 人们应该检查他们的计划,看看什么样的服务需要这个批准.

 

This can also be called:

 

  • Precertification
  • 授权
  • 之前的授权

*在德克萨斯州, 这种批准被称为服役前使用审查,而不是根据德州法律定义的核查.

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一段时间的残疾证明

This is a way to decide if a worker is truly disabled. 保单条款是用来决定这一点的.

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化疗

This is a cancer treatment. 它涉及化学或生物药物. 这些药物通常通过静脉给药.

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按摩保健

这种疗法用于帮助治疗脊柱、关节疼痛和运动问题. 有执照的脊椎按摩师提供这种护理.

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临床政策公告(CPBs)

健康保险公司使用这些文件为其成员解释保险决定的基础. In them, you can find details about how services are covered, or not covered. 你也可以找到一些特殊的指导方针,你可能需要满足一些服务的要求.

 

Insurers use objective sources to make these decisions, 比如专家意见或科学文献.

 

You may hear other terms that mean the same thing as CPBs. 一个例子是“覆盖率确定指南”.另一个是“医疗保险指南”." 

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claim

This is a request to be paid by a health plan for health services given. 一个例子是你的医生给你的健康计划发送的办公室访问的索赔. It is also a request for payment under a disability or life insurance plan.

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封闭的规定

A formulary is a list of prescription drugs the health plan covers. 如果该计划有一个封闭的处方,它只涵盖清单上的药物. It will not cover any part of the cost of non-formulary drugs. However, in some instances, a plan may be willing to make an exception. To get one, you need to contact the plan and tell them why the drug is needed.

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cms

也被称为 Centers for 医疗保险 & 医疗补助服务. This is a federal agency. 它运行着医疗保险计划. It also works with states to run the 医疗补助计划 program.

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COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986)

COBRA是保险法的延续. 它要求大多数团体健康计划在某些情况下提供团体健康保险的临时延续. COBRA覆盖符合条件的雇员、他们的配偶、前配偶和受抚养的子女. 如果当选,他们可以保留他们的保险,否则他们会因为以下原因失去保险:

 

  • 有保险的员工的死亡
  • 因严重不当行为以外的原因终止或减少受保员工的雇佣时间
  • Divorce or legal separation from a covered employee
  • 有保险的员工将有资格享受医疗保险
  • A child's loss of dependent status (and 因此 coverage) under the plan
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共同保险

This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum.

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cola

也被称为生活调整成本. 这是一个可选的福利. 这是一些长期残疾计划的一部分. 它每年都会提高每月的福利金额. The person on disability gets more money based on the cost of living. 这些加薪只在一段时间内给出.

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联合寿险最高额

This is the highest amount of life insurance you can get. 这意味着你可以有基本和补充计划,但只能在这个数量.

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习惯法婚姻

This is when two people live together for a certain amount of time. They think of themselves as married because of the time spent together. 一些州同意并承认他们已经结婚.

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Complication of pregnancy

This is a health problem that happens during pregnancy. It is something that would not happen in a normal pregnancy. 它可以影响婴儿,母亲或两者.

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复合

This is a type of filling that matches your natural tooth color.

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Congenitally missing teeth

这些牙齿根本不存在于你的嘴里. This is a condition that existed at, or dates from, your birth.

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式健康计划

This plan helps you control more of your health benefit dollars. 它包括一个基金或账户,可以用来支付你的医疗费用. Most health funds allow unused dollars to be rolled over from year to year, for as long as you stay in the plan. Some plans allow the fund to go with you, even if you change jobs.

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消费主义

这是医疗保健领域的一个新运动. Its goal is to have everyone more involved in their own care. 这意味着人们将有更多的信息来做出更好的医疗决定. 它包括了解医疗保健的实际成本,并在管理这些成本方面发挥积极作用.

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Contract (also known as a benefit certificate or policy)

This is a legal agreement. It is between a customer (an individual or group) and an insurance plan. 它列出了该计划覆盖范围的所有细节.

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合同持有人

This is a legal term. 指从保险公司购买保险计划的客户(个人或团体).

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共同海损分摊

This refers to a group health plan. It means costs are shared between an employer and its employees.

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转换费

这是更改保单所收取的费用. It must be paid when you change a group health plan to an individual policy.

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转换选项

This means people can buy a policy on their own after they leave a group plan. It may be offered with certain health and life insurance plans. It is often another choice besides COBRA coverage for health plans.

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利益协调(COB)

这些规则用于决定那些有多个计划的人先支付哪个计划. 这有助于协调覆盖范围,并允许索赔信息由计划共享. 这样,该计划可以避免重复付款.

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copay

This is the dollar amount you pay for health care expenses. In most plans, you pay this after you meet your deductible limit. For example, you pay a set dollar amount to your doctor for an office visit. So, if your copay is $25, you pay that amount when you go to your doctor. 在最初的医疗保险计划中,共付医疗费也用于一些医院门诊服务. In prescription drug plans, it is the amount you pay for covered drugs.

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共同付费

也被称为copay. This is the dollar amount you pay for health care expenses. In most plans, you pay this after you meet your deductible limit. For example, you pay a set dollar amount to your doctor for an office visit. So, if your copay is $25, you pay that amount when you go to your doctor. 在最初的医疗保险计划中,共付医疗费也用于一些医院门诊服务. In prescription drug plans, it is the amount you pay for covered drugs.

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成本估计

This online tool makes it easy to compare costs for office visits, procedures and more at different doctors and hospitals. 这些估计是基于你的健康计划. The tool factors in your deductible, coinsurance and copays. 它显示了正规的电竞竞猜软件保险将支付的价格.

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生活费用调整(cola)

这是一个可选的福利. 这是一些长期残疾计划的一部分. 它每年都会提高每月的福利金额. The person on disability gets more money based on the cost of living. 这些加薪只在一段时间内给出.

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覆盖缺口

This is also called the donut hole. 这是医疗保险计划的一部分,其中成员支付处方药. The plan does not pay. The gap occurs after you reach your initial coverage limit. It lasts until the expenses you pay add up to a certain amount.

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Covered services (also covered benefits or covered expenses)

These are services or supplies your health plan covers. 他们有资格从你的计划中获得报酬.

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的认证

这是一个过程. It is used to be sure doctors and hospitals meet certain standards. It is also used for other health professionals and facilities.

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可信的报道

也被称为先前可信的保险. This term means types of health coverage a person has had. 人们有时需要证明他们有这个,这样他们就可以被一个新的计划完全覆盖.

 

一些可接受的类型的例子如下:

 

  • 团体或个人保险
  • 医疗保险
  • 医疗补助计划
  • 军警人员的保健
  • A program of the Indian Health Service
  • 一个州健康福利风险池
  • 联邦雇员健康福利计划
  • A public health plan (any plan established by a state, the government of the United States, or any subdivision of a state or of the government of the United States, or a foreign country)
  • Any health benefits plan under Section 5(e) of the Peace Corps Act
  • The State Children's Health Insurance Program (S-CHIP)
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可信的保险——医疗保险

This applies to people who are eligible for 医疗保险. It is coverage that is at least as good as the 医疗保险 drug plan. If you have such a prescription drug plan, you can stay in your plan. You will not be charged higher fees if you switch to 医疗保险 later.

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监护

This is care that helps people with daily life activities. The person giving the care does not have to be trained in medicine. This care may help people with walking, bathing, dressing and eating.

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Customary and reasonable

你的健康计划将支付的金额的限制. 也称为通常的、习惯的和合理的(ucr)、合理的或普遍的收费. 这个限制是基于aetna收到的数据. The data is based on what doctors charge for the health care service. We receive this data from Fair Health, an independent organization.

 

查看您的计划文件了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外的医疗. Or call 会员服务 at the phone number listed on your aetna 身份证.

D

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Date claim incurred (dci)

这是给残疾人的. 这是一个人成为残疾人的日期.

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声称收到日期

This is the date the insurance company receives the claim.

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Date last worked (dlw)

This is the last day a person worked before becoming disabled. For long-term disability, it is the last day the person worked part of a day. 对于短期残疾,这是一个人工作半天以上的最后一天.

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Date of disability (also known as date of claim or incurred date)

这是一个人成为残疾人的日期. The person must meet the plan definition of disabled.

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Day treatment center

This is a place where people can get mental health care. They don't stay overnight. They visit the treatment provider as needed for care.

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dci

也被称为 date claim incurred. 这是给残疾人的. 这是一个人成为残疾人的日期.

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死亡抚恤金(也称为面值)

这适用于人寿保险. It is the money that an insurance company pays when an insured member dies.

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可扣除的

The amount you pay for covered services before your health plan begins to pay.

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可扣除的 (医疗保险)

这是在医疗保险计划开始支付之前你必须支付的医疗保健费用. 这个数字每年都在变化.

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Defined contribution plans

这些计划有许多不同的类型. In them, employers give each worker a fixed amount of money. The worker can use the money for retirement, health or some other benefit. When the plan is for health benefits, the money can be used to pay for health insurance or health services.

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依赖

This is a person who is covered by another person's plan. 可以是孩子、配偶或家庭伴侣.

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依赖 care reimbursement account

You can put money into this account before taxes are taken. You can use the money later to pay for eligible childcare expenses. No taxes are taken out, so you lower your taxable income rate. 金钱并不能产生兴趣. 它不能延期到明年. Also, the money cannot be taken from one job to another.

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诊断测试

These are tests that a health care professional orders. The tests help see if a person has a condition or a disease. x - rays and ultrasounds are examples of these tests.

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直接取用(亦称开放取用)

这是一种健康计划. 该计划允许您直接前往该计划网络中的医疗保健专业人员,而无需转诊.

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残疾

There are two types of disability:

 

Long-term disability (LTD): 员工可能生病或受伤. 他们可能无法工作很长一段时间. 通过雇主提供的有限利益可以保护他们和他们的家人免受经济损失. 它在一定时间内提供了一种收入来源. This helps to maintain a percentage of the employees' pre-disability income. 有限公司计划以外的其他收入福利可能会减少根据有限公司计划应付的金额. See "Other income benefits."

 

短期残疾:这是在工人失业时支付工人工资的一部分. 他们必须在短时间内因与工作无关的疾病或受伤而失业.

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残疾和缺勤管理

这些是服务和产品. They help businesses track and manage when workers are out. This includes general absences and leaves of absence.

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残疾付款

This is the money paid to a member who is disabled.

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疾病管理

This is a type of program that comes with some health plans. It is used to help people who live with a chronic illness. It helps members manage their health and prevent future problems.

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dlw

也叫上次工作的日期. This is the last day a person worked before becoming disabled. For long-term disability, it is the last day the person worked part of a day. 对于短期残疾,这是一个人工作半天以上的最后一天.

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dme

又称耐用医疗设备. 这是一个人需要的设备,即:

 

  • Made for and mainly used to treat a disease or injury
  • Reusable and made for long-term use
  • Appropriate for home use
  • Not for use in altering air quality or temperature
  • Not for general exercise or training

Examples are a wheelchair or hospital bed used in the home.

 

医疗保险患者:这些设备是医生为家庭使用订购的. They must be reusable. Some examples are walkers, wheelchairs or hospital beds. They are covered under 医疗保险部分 and Part B for home health services.

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国内合作伙伴

This means two people who live together but are not married. They are responsible for each other's well-being and finances. 他们可能是也可能不是同性伴侣.

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Donut hole (医疗保险)

也被称为 coverage gap. 这是医疗保险计划的一部分,其中成员支付处方药. The plan does not pay. The gap occurs after you reach your initial coverage limit. It lasts until the expenses you pay add up to a certain amount.

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drug

This is a natural or man-made substance used to treat an illness.

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药物配方

也被称为 a formulary. This is a list of prescription drugs the health plan covers. It can include drugs that are brand name and generic. drugs on this list may cost less than drugs not on the list. 不同药物的保险金额不同. An open formulary provides a greater choice of covered drugs. 它也被称为首选药物列表.

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药物层

These are groups of different drugs. 通常,医保计划会根据价格对药物进行分组. 每一组或层次需要不同的coppay. 您可能会看到这些组被列为仿制药、品牌药或首选品牌药. 仿制药s often have lower copays. 名牌药物s have higher copays.

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Dual eligibles (医疗保险)

这些人可以通过两种计划获得利益:医疗保险和医疗补助.

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重复的报道

这是指你和你的家属通过两个或更多的健康计划获得相同的保险.

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耐用医疗设备(dme)

这是一个人需要的设备,即:

 

  • Made for and mainly used to treat a disease or injury
  • Reusable and made for long-term use
  • Appropriate for home use
  • Not for use in altering air quality or temperature
  • Not for general exercise or training

Examples are a wheelchair or hospital bed used in the home.

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耐用医疗设备(医疗保险)

These are devices that doctors order for use in the home. They must be reusable. Some examples are walkers, wheelchairs or hospital beds. They are covered under 医疗保险部分 and Part B for home health.

E

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紧急

也被称为员工援助计划. 这可以帮助人们平衡工作和生活问题. 它提供支持和咨询,帮助人们处理压力,家庭问题等. The program is for employees, their dependents and household members. 雇主购买它. 工人不用支付使用紧急的费用.

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收入的定义

This is the base pay for calculating disability benefits. 好处可能是短期的,也可能是长期的. The pay does not include bonuses, overtime or other extra pay. Some types of pay, like commissions, may be offered. It depends on the policy.

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生效日期

这是你的健康计划开始生效的日期. 你的报道从今天开始.

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资格

This includes terms that decide who can get coverage. The requirements vary. 这些数据可能包括健康状况、受雇时间、工作状况等.

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消除时间

这是人们在获得长期残疾福利之前必须残疾的时间. 政策规定了时间的长短. 在此期间或此期间不支付任何福利.

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紧急

This is a serious illness or injury. It comes on suddenly. 这种病需要立即治疗. 如果一个人不迅速得到治疗,可能会死亡或严重的健康问题.

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应急设施

This is a place that offers short-term care on the spot. People usually go to one when they have a sudden illness or injury. 医院和诊所就是两个例子.

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员工援助计划(紧急)

这可以帮助人们平衡工作和生活问题. 它提供支持和咨询,帮助人们处理压力,家庭问题等. The program is for employees, their dependents and household members. 雇主购买它. 工人不用支付使用紧急的费用.

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Employee Retirement Income Security Act of 1974 (erisa)

这是一条定律. 它控制着以雇主为基础的健康计划. It also sets rules for pensions and other benefits plans.

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电子健康记录(EHR)

This is a digital version of a patient's medical history. 正规的电竞竞猜软件的目标是让所有参与病人护理的专业人员都在这个记录中输入详细信息. 那可能是你的主治医生或专家. 或者药店,医院和实验室.

 

电子病历可能包括服用的药物、化验结果和生命体征等细节.

 

Patient information can now be easily seen and shared across all providers. 所以对病人的健康有一个更广阔的视角.

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被征入伍者

也被称为 a member. 成员是属于健康计划的人. 有时一名成员被称为注册者.

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登记期(医疗保险)

This is when people can sign up for a 医疗保险 health plan. At this time, the plan accepts people new to 医疗保险. 该计划还必须允许拥有不同医疗保险计划的所有符合条件的人加入.

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紧急医疗运输

从事故现场或紧急医疗事故现场到最近的可提供必要护理的设施,使用配备特殊设备的合格车辆进行当地运输.

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紧急服务

关于紧急医疗状况, 在医院急诊科能力范围内以及医院工作人员和设施能力范围内进行的体检, 为使病人病情稳定所需要的进一步医疗检查和治疗.

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eob

参见“福利解释”." This is a statement a health plan sends to a health plan member. 它显示了费用,付款和任何欠款. 它可以通过邮件或电子邮件发送.

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eoi

见“可保性证据”."

 

Ergonomic evaluation

 

它着眼于一个人的实际工作空间. The goal is to make sure it is safe and comfortable. It's important that the equipment a worker uses gives proper support. Doing this helps lower the risk of work-related injuries. 

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人体工程学

This is an applied science. 它要求创建一个适合和支持工人的物理工作环境. The idea is to help workers be physically safe and comfortable. This is important to workers' health while they do daily tasks. It could mean having the right chair, 键盘或桌子上, or a headset if a worker has to be on the telephone a lot.

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erisa

也被称为 the Employee Retirement Income Security Act of 1974. 这是一条定律. 它控制着以雇主为基础的健康计划. It also sets rules for pensions and other benefits plans.

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Essential health benefits

This refers to a set of health care service categories. 《电竞竞猜比较正规的》(Affordable Care Act)要求个人和小群体市场的某些保险计划覆盖这些类别. The categories include:

 

  • Ambulatory patient services
  • 紧急服务
  • 住院治疗
  • Maternity and newborn care
  • 精神健康和物质使用障碍服务,包括行为健康治疗
  • 处方药
  • 帮助某人的服务和设备:

    • 恢复因疾病或受伤而失去的技能和能力(康复服务)
    • Develop skills and abilities that may not be developing normally, 例如,一个孩子没有按照孩子的年龄预期说话(适龄服务)
  • 实验室服务
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

只有覆盖这些福利的计划才能在健康保险市场上得到认证和提供. 扩大医疗补助计划的州必须向新符合资格的人提供这些福利.

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Evidence-based medicine

这是医生利用最新的研究结果来帮助他们对病人的护理做出决定. They combine it with their own expertise and what they learn from the patient.

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Evidence of insurability (eoi, also known as medical underwriting)

团体或个人在申请健康或人寿保险时,可能需要经过这个过程. eoi may also be needed when someone wants more coverage or is enrolling late. It helps the insurer decide whether to cover the person or group. The process might include:

 

  • 一份意向书——应聘者应回答的有关健康状况的问题
  • 医学考试
  • 测试,如心脏
  • Report from the applicant's doctor
  • 其他信息,如有需要
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交换

See "健康保险市场."

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除外责任

These are conditions or services that the health plan does not cover.

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Experimental services or procedures

这些通常是更新的药物、治疗或测试. 它们还没有被医生或保险计划接受为标准治疗. They may not be proven as effective or safe for most people.

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福利解释(eob)

This is a statement a health plan sends to a health plan member. 它显示了费用,付款和任何欠款. 它可以通过邮件或电子邮件发送.

F

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票面金额

也被称为死亡抚恤金. 这适用于人寿保险. It is the money that an insurance company pays when an insured member dies.

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Facility-of-payment条款

这可能是人寿保险的一部分. 它允许保险公司在最终索赔解决之前支付一部分赔偿金. The money can go to a beneficiary. 也可以送给朋友或亲戚. The money is often used to pay for funeral costs or other related costs.

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Family and Medical Leave Act (fmla)

这是一条定律 for employers with 50 or more workers. It applies to workers who need to take time off from work for:

 

  • Birth and care of a newborn child up to 12 months old
  • Adoption or foster care of a child
  • 照顾有严重健康问题的直系亲属(配偶、子女或父母)
  • 因严重的健康状况而导致工人无法工作的病假

Workers can get up to 12 workweeks of unpaid leave per year if they qualify. 这项法律还规定了军人及其家属的某些权利.

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联邦雇员健康福利计划(fehbp)

这是一种健康计划. Most federal government workers are covered under it.

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Federal poverty level (FPL)

卫生与公众服务部每年发布的收入水平衡量标准. 联邦贫困水平被用来确定某些项目和福利的资格.

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联邦合格保健中心(FQHC)

These are federally funded nonprofit health centers or clinics. They serve medically underserved areas and populations. They provide primary care services. The amount they charge is based on the person's ability to pay.

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服务费

这是一些健康计划使用的过程. 它允许计划为医生和其他提供者提供的每项服务支付费用.

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fehbp

也被称为 Federal Employees Health 好处s Program. 这是一种健康计划. Most federal government workers are covered under it.

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灵活支出账户(fsa)

This is a way workers can set aside money to help pay for health care. fsa与健康福利计划一起使用. Workers ask for money to be taken from their pay each pay period. This money is not taxed in most states. 这些钱进入一个基金,工人可以用来支付不同的健康费用. All money must be used by the end of the stated year or it will be lost. This money cannot be transferred to another job or account.

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fmla

也被称为家庭和医疗休假法案. 这是一条定律 for employers with 50 or more workers. It applies to workers who need to take time off from work for:

 

  • Birth and care of a newborn child up to 12 months old
  • Adoption or foster care of a child
  • 照顾有严重健康问题的直系亲属(配偶、子女或父母)
  • 因严重的健康状况而导致工人无法工作的病假

Workers can get up to 12 workweeks of unpaid leave per year if they qualify. 这项法律还规定了军人及其家属的某些权利.

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规定的

This is a list of prescription drugs the health plan covers. It can include drugs that are brand name and generic. drugs on this list may cost less than drugs not on the list. 不同药物的保险金额不同. An open formulary provides a greater choice of covered drugs. 它也被称为首选药物列表.

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规定的 exclusion list

This is a list of prescription drugs not covered by a health plan. It applies to closed formulary plans. 如果一个成员需要这张清单上的一种药物,医生必须要求医保计划作为例外来覆盖它. The plan will only do so if use is medically necessary.

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fsa

参见“灵活支出账户”."

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Fully insured employers

这些雇主付钱给健康计划提供者,让他们管理和管理他们选择的福利. The insurer pays the claims. 这意味着保险公司是承担风险的一方.

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功能性能力评估

This exam is done by occupational or physical therapists. 它测试受伤或生病的人,看他们是否能重返工作岗位. It might test how well a person can lift, bend, stand, climb or carry. It can also focus on a specific function, like use of the hands. The tests used show if the worker can resume normal job activities.

G

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仿制药

A generic drug is a copy of a brand-name drug that no longer has a patent. 这种药的成本通常比名牌药低.

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黄金健康计划

See "Health plan categories."

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不满

由承保人或代表承保人就下列事项提交的书面或口头投诉:A)可用性, delivery or quality of health care services; b) claims payment, handling or reimbursement for health care services; or c) matters pertaining to the contractual relationship between a covered person and a health carrier.

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团体保险

This is a plan offered by a plan sponsor to an employee group or other group. The plans offer health, dental, life insurance coverage and more. 退休人员也可享受团体计划.

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团体保险

也被称为团体保险. This is a plan offered by a plan sponsor to an employee group or other group. The plans offer health, dental, life insurance coverage and more. 退休人员也可享受团体计划.

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Group universal life (gul)

这是一种人寿保险产品. It offers a death benefit. It also lets members build up a fund that helps them save on taxes. If members leave the group or retire, they can take their coverage with them.

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Guarantee issue maximum

这适用于人寿保险 plans. It is the dollar amount a person may qualify for without proof of good health.

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gul

也被称为 group universal life. 这适用于人寿保险 plans. It is the dollar amount a person may qualify for without proof of good health.

H

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Habilitation services

Occupational therapy, 物理治疗, 由医生根据治疗计划规定的语言治疗和其他服务,以提高先天性儿童的功能能力, genetic or early acquired disorder, including but not limited to health care services that help a person keep, learn, or improve skills and functioning for daily living.

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hdhp

也被称为高免赔额健康计划. 这个医疗计划必须符合联邦规定. 这样会员就可以把钱存入健康储蓄账户或健康报销安排. 这些资金可以帮助支付医疗保健费用. The plan deductible is higher than a standard health plan. 费用较低.

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健康评估

健康评估是一种表格或在线工具,可以帮助你了解自己的健康状况. It also helps you see if you are at risk for future illnesses. It gathers information by asking a series of questions. It may be used to help decide which health programs would be good for you.

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Health benefits plan

This is any plan that helps pay for health care services. 计划有很多种. 有些服务仅限于某些类型的服务. Some plans cover only hospitalizations, for example. 一些计划为医生提供开放访问. 有些网站只提供网络医生服务.

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Health care consumerism

也被称为 consumerism. 这是医疗保健领域的一个新运动. Its goal is to have everyone more involved in their own care. 这意味着人们将有更多的信息来做出更好的医疗决定. 它包括了解医疗保健的实际成本,并在管理这些成本方面发挥积极作用.

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健康基金

This is an account set up to help members pay for health care costs. In some funds, money is put into the fund for them. 在另一些情况下,他们可以自己投资. 有些基金两样都做. 还有正规的电竞竞猜软件健康基金的计划®.

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Health insurance carrier

This is a company that provides health insurance plans.

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健康保险市场

A resource where individuals, families and small businesses can:

 

  • 了解他们的健康保险选择
  • 根据成本、福利和其他重要特性比较健康保险计划
  • 选择一个计划
  • 参加保险

该市场还提供有关帮助能力有限的人支付保险的项目的信息. 这包括:

 

  • 如何节省每月保费和可通过市场获得的保险费用
  • 有关其他程序的信息, including 医疗补助计划 and the Children's Health Insurance Program (CHIP)

The marketplace encourages competition among private health plans. It is accessible through websites, call centers and in-person assistance.

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Health Insurance 可移植性 and Accountability Act (hipaa)

This is a federal law. 它限制了团体健康计划对已存在健康问题的福利的规定. It gives people access to quality health care coverage when they switch jobs. 这项法律不允许团体健康计划因一个人先前的健康状况而收取更高的费用. It can also limit rules on some individual health plans. The law also helps protect private health information. It sets national standards for handling private health records.

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Health maintenance organization (hmo)

This is a health plan that arranges health care services for its members. In most hmo plans, members choose a primary care physician (pct). The pct is from the health plan's provider network. pct提供常规护理,如果需要特殊护理,则会将会员介绍给网络医生.

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健康维护组织(医疗保险)

这是一种健康计划. 该计划有一个医生和医院网络,帮助协调你的治疗. 这让你获得比原来的医疗保险计划更多的福利. It also gives you more benefits than many 医疗保险 supplemental plans.

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Health plan categories

健康保险市场中的计划主要在四个健康计划类别中提供——青铜计划, silver, gold, 或铂. The categories determine the percentage of health care costs the plan covers. The plan category affects the total amount you'll spend on health benefits. The percentages the plans will spend, on average, are:

 

  • 铜:60%
  • 银:70%
  • 黄金:80%
  • Platinum: 90 percent

This is not the same as coinsurance. 共同保险是指你支付特定服务费用的特定百分比. 

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医疗报销安排(hra)

这是一个健康计划的一部分,该计划允许成员使用一个基金来支付医疗费用. 会员的雇主将钱存入一个基金. 成员可以使用该基金支付免赔额、共同保险和其他涵盖的医疗保健费用. Unused money can usually be rolled over and used in the next plan year.

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健康储蓄账户(hsa)

这是健康计划的一部分. You can put money into this account. You can use it to pay for covered health care costs. Or you can save money in it for future health care costs. The account grows interest. You can take your account with you if you leave your job. You must be covered by a high­deductible health plan to qualify for an hsa.

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High-deductible health plan (hdhp)

这个医疗计划必须符合联邦规定. 这样会员就可以把钱存入健康储蓄账户或健康报销安排. 这些资金可以帮助支付医疗保健费用. The plan deductible is higher than a standard health plan. 费用较低.

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hipaa

也被称为 the Health Insurance 可移植性 and Accountability Act. This is a federal law. 它限制了团体健康计划对已存在健康问题的福利的规定. 它的通过是为了让人们在换工作时能够获得高质量的医疗保险. 这项法律不允许团体健康计划因一个人先前的健康状况而收取更高的费用. It can also limit rules on some individual health plans. The law also helps protect private health information. It sets national standards for handling private health records.

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hmo

又称养生组织. This is a health plan that arranges health care services for its members. In most hmo plans, members choose a primary care physician (pct). The pct is from the health plan's provider network. pct提供常规护理,如果需要特殊护理,则会将会员介绍给网络医生.

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家庭健康护理

家庭健康护理 means health care services a patient receives at home. 它通常在住院后提供. Coverage depends on the patient's needs and health plan.

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Home infusion therapy

This is a type of medical treatment offered in a patient's home. 病人通过静脉取药. 营养和液体也可以通过这种方式给予.

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临终关怀

这是一种为生病和濒临死亡的病人提供的护理和支持性护理. 这种护理可以在设施或家中进行.

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医院

这是一个提供医疗服务的地方. Patients can stay overnight for care. 或者他们可以接受治疗并在当天离开. 所有医院都必须达到既定的护理标准. They can offer general or acute care. They can also offer service in one area, like rehabilitation.

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hra

也被称为医疗报销安排. 这是一个健康计划的一部分,该计划允许成员使用一个基金来支付医疗费用. 会员的雇主将钱存入一个基金. 成员可以使用该基金支付免赔额、共同保险和其他涵盖的医疗保健费用. Unused money can usually be rolled over and used in the next plan year.

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hsa

也被称为 health savings account. 这是健康计划的一部分. You can put money into this account. You can use it to pay for covered health care costs. Or, you can save money in it for future health care costs. The account grows interest. You can take your account with you if you leave your job. You must be covered by a high-deductible health plan to qualify for an hsa.

I

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身份证

This is the card members get when they join a health plan. 它帮助医生和其他卫生保健提供者了解病人的保险范围. It shows the member's assigned plan number and plan contact information. members should show the card at every health care visit.

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补偿方案

这是一种健康计划. members can get care from any licensed doctor or hospital. They get the same level of benefits no matter who they see. 没有网络. The plan pays a percentage of each covered health care service. These plans often have deductibles, coinsurance and certain benefit maximums. 这也被称为传统计划.

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Independent medical exam

This is needed to help decide on a disability claim. 医生对病人进行检查. 这位医生以前没有治疗过这个人.

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独立实践协会(ipa)

This is a group of doctors or other health care providers. They contract with one or more health plans to provide services. 一名看过该组主治医生的成员将被转介到同一组的专家和医院. 如果群体不能满足他们的医疗需求,成员可以离开群体.

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个人强制保险

This is also known as penalty, fine or individual responsibility payment. 从2014年开始, 《电竞竞猜比较正规的》要求大多数人为自己和受抚养人购买医疗保险. 不这样做的人可能要支付罚款. Some people will be exempt from the mandate or the penalty. Others may be given financial help to pay for health insurance.

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个人的政策

这是一种健康计划,由不能通过团体计划获得利益的人购买. Self-employed people often have to buy this type of plan. 那些无法从雇主或其他群体那里获得健康福利的人也是如此.

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Individual retirement account (爱尔兰共和军)

This is an account you can use to save for retirement. You can put in a certain amount of money each year. This amount can be deducted from the taxable income you report. Contributions and interest are not taxed until money is taken out.

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输液治疗

这是一种进入静脉的治疗方法. 它包括药物或喂养. It can also deliver nutrients into the stomach by tube.

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Initial coverage limit

This is the first part of a 医疗保险处方药计划. 一个会员支付一个固定的金额,直到会员和计划支付达到一定的总额. 一旦达到这个极限,条款就会改变. members may pay more as the plan moves to the coverage-gap phase.

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初始注册期(IEP)

这个时期持续7个月. 它集中在你有资格享受医疗保险的事件上——例如,你的65岁生日. 它持续在事件发生前三个月、事件发生前一个月和事件发生后三个月.

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注射药物

This is a drug that is given with a needle or syringe. The medicine is put under the skin, into a muscle or into a vein. 它一开始可能是一种与水混合的粉末.

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在网络

This means we have a contract with that doctor or other health care provider. We negotiate reduced rates with them to help you save money. Your out­of-pocket costs are lower when you stay in network.

 

There are other benefits to using doctors in network. 他们不会要求您支付他们的标准费率与他们与正规的电竞竞猜软件商定的费率之间的差额. All you have to pay is your coinsurance or copay, along with any deductible. And network doctors will handle any precertification your plan requires. 

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住院病人

这是一个必须在医院里呆上至少一晚的人.

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住院病人护理

This is care given to a person who has been admitted to the hospital. 这个人会住一个或多个晚上.

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保险卡

也被称为 身份证. This is the card members get when they join a health plan. 它帮助医生和其他卫生保健提供者了解病人的保险范围. It shows the member's assigned plan number and plan contact information. The card should be shown at every health care visit.

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综合保健和残疾

This program is for members who have health and disability coverage. It combines services from both plans. It gives members special help so they can return to work faster.

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lnvestigational services

也被称为实验性服务或程序. 这些通常是更新的药物、治疗或测试. 它们还没有被医生或保险计划接受为标准治疗. They may not be proven as effective or safe for most people.

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ipa

又称独立执业协会. This is a group of doctors or other health care providers. They contract with one or more health plans to provide services. 一名看过该组主治医生的成员将被转介到同一组的专家和医院. 如果群体不能满足他们的医疗需求,成员可以离开群体.

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爱尔兰共和军

参见个人退休帐户. 这是一种健康计划,由不能通过团体计划获得利益的人购买. Self-employed people often have to buy this type of plan. 那些无法从雇主或其他群体那里获得健康福利的人也是如此.

J

K

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失效(或保险责任失效)

任何购买保险计划的人都要付保险费. 你每个月都要付这笔钱. If you miss a payment, the insurance company can cancel your coverage. It means you have let your insurance coverage lapse. You have let it end.

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晚入学者(亦称晚入学者)

一年中的某些时候,工人可以选择或改变福利. 主要时间被称为开放注册. 新雇员可以在他们第一次开始工作时登记. 当生活发生变化时,那些结婚或有孩子的人可以改变他们的保险.

 

后期进入者是:

 

  • New employees who do not sign up within 31 days of being hired. 后来,他们在公开登记期间选择了保险.
  • 在结婚或生孩子31天内没有选择或改变保险范围的员工. 后来,他们在开放注册期间这样做.
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Length of disability

This is how long a person is certified as disabled.

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滞留时间

This is the number of days a patient stays in the hospital for treatment. Days are counted in a row.

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水平量计划(也称为固定量)

This is a benefits schedule. 它列出了每个工人得到多少福利. 所有工人都得到相同的福利. There are different schedules for different types of workers.

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人寿保险

Buying this means your loved ones can get money when you die. 你可以选择保险金额. A premium must be paid to keep this policy active every year. 你也可以选择一个受益人. This is a person who you want to receive the money after your death. Employers may offer this as a benefit to their workers. 你也可以自己买. 人寿保险有很多种:定期人寿保险、终身人寿保险、团体通用人寿保险和其他.

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威胁生命的

This means a condition is dangerous. You could lose your life. 不等医生来吗.

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一生中最大的

This is the total dollar amount of benefits you can receive. It can also be the total number of services you can receive. These totals are limits for a lifetime, not just for a plan year. 受联邦医疗改革影响的计划,非必要福利的最高终身金额.

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限制

These are restrictions that health plans place on coverage. 他们说你的计划不包括什么.

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生活将会

也被称为预先指令. 这份法律文件告诉你的医生你想要或不想要什么样的治疗. Doctors use it when you are too sick to make medical decisions on your own.

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Long-term care insurance

Long-term care services are costly. Health plans, disability insurance and 医疗保险 do not help much. 他们不适合这种护理. Long- term care insurance can help cover the cost of this care.

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Long-term care services

这些是个人护理服务. They help people who cannot care for themselves anymore. Services include help with bathing, dressing and eating. Services may involve constant supervision and care. This care may be given at home or adult day care centers. It can also be given at assisted living facilities and nursing homes.

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Long-term disability (LTD)

员工可能生病或受伤. 他们可能无法工作很长一段时间. 通过雇主提供的有限利益可以保护他们和他们的家人免受经济损失. 它在一定时间内提供了一种收入来源. This helps to maintain a percentage of the employees' pre-disability income. 有限公司计划以外的其他收入福利可能会减少根据有限公司计划应付的金额. See "Other income benefits."

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长期伤残抚恤金应计

This is for workers who will receive a pension when they retire. 如果他们是残疾人,不能工作很长一段时间,他们可能失去他们的全部养老金. This benefit pays into their pension even when they are disabled. It helps them get the full amount when they retire.

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长期残疾(有限)养恤金补助费

This is for workers who will receive a pension when they retire. 如果他们是残疾人,不能工作很长一段时间,他们可能失去他们的全部养老金. This benefit adds a little extra to their pension fund payments at retirement. 这弥补了他们在残疾期间的损失.

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回顾周期

This is used mostly in health plans people buy on their own. 健康保险公司查看他们的健康记录能追溯到多久以前. If the period is five years, 人们必须列出他们在过去五年中患有或治疗过的所有疾病.

 

如果名单有误或有某些健康问题,公司可以拒绝. They can also say yes and call for a pre-existing condition waiting period. This is the time someone must wait before the condition will be covered.

 

残疾计划也有回顾期. They may exclude benefits for disabilities caused by pre-existing conditions.

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最低平均批发价格

This is a reference price. It is the lowest cost that pharmacies, doctors and health plans might pay for a prescription drug on the market.

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邮购药品

也被称为 maintenance medications. These are prescription drugs that people take on a regular basis. 这些药物有助于治疗慢性疾病. 这些药物包括治疗哮喘、糖尿病、高血压和其他健康问题的药物. Buying them through a mail-order pharmacy can save money.

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邮购药店

People can get prescription drugs through the mail with this. 这是一种健康计划经常提供的服务. 会员可以通过一次性获得三个月的供应来节省时间和金钱. CVS Caremark® Mail Service 药店 is the name of the mail-order pharmacy.

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Maintenance medications

These are prescription drugs that people take on a regular basis. 这些药物有助于治疗慢性疾病. 这些药物包括治疗哮喘、糖尿病、高血压和其他健康问题的药物. Buying them through a mail-order pharmacy can save money.

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恶性

This is a word to describe a tumor that shows signs of cancer. It can grow and spread in the body. 参见“转移性”.)"

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管理式医疗

这是一种健康计划. It is an agreement signed with doctors and hospitals to form a network. 如果会员在这个网络中使用医生或医院,他们可以获得更高水平的利益. Costs are often higher when people go out of the network for care. The plan may also require preapproval of some services.

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管理式医疗 company

This is a health insurance company. See also "管理式医疗."

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授权的好处

These are the benefits that health care plans must provide. State or federal law requires them.

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马计划

这是一种医疗保险优先计划. It does not cover prescription drugs.

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MA-PD计划

这是一种医疗保险优先计划. 包括处方药.

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市场

See "健康保险市场."

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Maximum benefit amount

这是通过残疾计划或人寿保险支付给人们的一笔钱. It is the most that they can receive in one period. That could mean every week, every month, or once a year. 该计划规定了这笔钱的支付频率.

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Maximum benefit period

Some employers offer disability plans. These plans help people who cannot work because of illness or injury. 该计划支付他们一段时间的部分收入.

 

这是雇员可以通过他们的残疾计划获得福利金额的时间. It is the longest period of time that they can collect this money.

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Maximum drug benefit

This is a type of limit that some health plans have. It is the most the plan will pay for prescription drugs for a period of time. If a member's drug costs reach that limit within the time period, the plan will not cover the drug costs for the rest of that time.

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医疗补助计划

医疗补助计划 is a state government program. 它提供医疗保险. 它是为低收入人群设计的. This includes families and children.

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医疗紧急情况

也被称为 emergency. This is a serious illness or injury. It comes on suddenly. 这种病需要立即治疗. 如果一个人不迅速得到治疗,可能会死亡或严重的健康问题.

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Medical underwriting

也被称为可保性证据. 团体或个人在申请健康或人寿保险时,可能需要经过这个过程. It may also be needed when someone wants more coverage or is enrolling late. It helps the insurer decide whether to cover the person or group. The process might include:

 

  • 一份意向书——应聘者应回答的有关健康状况的问题
  • 医学考试
  • 测试,如心脏
  • Report from the applicant's doctor
  • 其他信息,如有需要

看到“末入学者."

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医学上必要的

也被称为 necessary. Health plans usually pay only for care that is necessary. 他们通过使用医疗标准或研究来确定哪种护理最有效. 护理可以指保健服务或用品. 这也被称为医疗必需品,医疗必需品服务或医疗必需品.

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医疗保险

这是联邦政府的一个项目. 它提供医疗保险. 它是给人们的:

 

  • 65岁或以上
  • With certain disabilities
  • Who have permanent kidney failure
  • 患有终末期肾病的患者, 需要透析治疗或肾移植的永久性肾衰竭
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医疗保险 Advantage plan

See "医疗保险部分C."

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医疗保险 limiting charge

This applies to a health care provider. 提供者不参与医疗保险. 对于医疗保险覆盖的服务,提供者可以收取多少费用是有限制的. The limit is 15% more than the amount 医疗保险 allows for the service.

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医疗保险 Modernization Act

这是一条定律. It:

 

  • 加强现有的医疗保险计划
  • Added coverage for preventive care
  • Created the 医疗保险D部分 prescription drug plan
  • 为低收入人群提供额外帮助
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医疗保险部分

这是原始医疗保险计划的一部分. 它由联邦政府管理. 它涵盖了以下方面的部分(但不是全部)开支:

 

  • 住院治疗在医院的住院治疗
  • 在专业护理机构接受医疗护理
  • 临终关怀
  • 家庭健康护理

该计划有其局限性. People also must pay deductibles, copays and other costs.

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医疗保险B部分

这是原始医疗保险计划的一部分 managed by the federal government. 人们报名参加这个计划. 他们通常每月为该计划支付保险费. 它涵盖了:

 

  • 医生提供的必要服务
  • 在医院接受门诊治疗

它也为一些支付一些费用:

 

  • 物理治疗
  • Occupational therapy
  • 家庭健康护理
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医疗保险部分C

This is a 医疗保险 program. It is open to most people who have 医疗保险部分 and 医疗保险B部分 plans.

 

它提供医疗和其他福利. 这些都是由联邦政府批准的健康计划公司提供的. The coverage is offered through 医疗保险 Advantage (MA) plans. 这些计划可以是:

 

  • 健康维护组织
  • 优先提供者组织
  • 医疗保险私人收费服务计划

当人们使用医保网络中的医生和医院时,他们可能会支付更少的费用.

其中一些计划包括处方药. That is an MA-PD计划. Some do not cover prescription drugs. 这是一个MA计划.

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医疗保险D部分

这是一个可选的医疗保险计划. 它为一些处方药提供保险.

 

  • It can be offered as part of a 医疗保险 Advantage plan. This is called an MA-PD.
  • It also can be offered separately from the 医疗保险 plan. This is called a 医疗保险处方药计划 or pdp.
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医疗保险处方药计划

这是一个可选的医疗保险计划. 它是独立于医疗保健计划的. 它为一些处方药提供保险. 它是通过一家私人公司提供的. 有时它被称为pdp.

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医疗保险 supplement plan

This is an insurance policy. 它是通过私人公司提供的. 它帮助支付一些医疗保险A部分和医疗保险B部分没有覆盖的福利. New plans of this type do not cover prescription drugs. It is also known as 补充性医疗保险 coverage.

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药物治疗

这是一种人服用的药物. It can be a prescription drug or an over-the-counter drug.

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补充性医疗保险

也被称为医疗保险补充计划. This is an insurance policy. 它是通过私人公司提供的. 它帮助支付一些医疗保险A部分和医疗保险B部分没有覆盖的福利. New plans of this type do not cover prescription drugs. It is also known as 补充性医疗保险 coverage.

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member

这是一家健康计划公司的部门. It helps people understand how their health plan works. it can:

 

  • 在电话中回答问题
  • Mail out plan documents
  • Replace member 身份证s

People usually find the phone number for 会员服务 on their 身份证.

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会员服务

这是一家健康计划公司的部门. It helps people understand how their health plan works. it can:

 

  • 在电话中回答问题
  • Mail out plan documents
  • Replace member 身份证s

人们通常会在他们的正规的电竞竞猜软件身份证上找到会员服务的电话号码.

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精神障碍

This is a problem with brain function. It affects the way people see themselves and the world they live in. 这也可能影响他们的行为.

 

Examples include depression, post-traumatic stress and schizophrenia. These types of conditions are not always easy to recognize. 它们不会在血液测试或x光检查中显示出来.

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Metastatic (metastasize)

This is a word that describes cancer. It means that the cancer has spread.

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方法

这是一种被遵循的方法或过程.

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Mg

This stands for milligram. 这是一个非常小的量用来衡量毒品.

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微蛋白尿

This is a condition in which high levels of protein are found in the urine. This could signal a kidney problem.

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最低收益

残疾计划为因病或受伤而不能工作的人提供一种收入来源. 其他来源的收入可以减少根据该计划支付的金额. 最低收益是指一个人能从这个计划中得到的最少的钱.

 

See "Other income benefits."

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Modified adjusted gross income (MAGI)

用于确定在医疗保险市场中获得较低成本的资格的数字, 医疗补助计划 and the Children's Health Insurance Program (CHIP). 一般, 调整后总收入是指你的调整后总收入加上任何免税的社会保险, interest or foreign income you have.

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每月的好处

这是为在长期残疾计划下的残疾员工提供的. 这是他们每个月能拿到的钱. They get this only while they are not able to work for a period of time.

N

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鼻塞

This means the same as stuffy nose.

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国家优势TM项目

This is an aetna program. 它为一些索赔提供合同费率. These claims would otherwise be paid at the cost the doctor billed. 适用于:

 

  • 赔偿计划
  • 管理医疗计划的网络外部分
  • 紧急 or necessary services not provided by the network

*aetna does not credential, 监督或监督那些通过第三方合同参与的供应商. Since several factors determine whether a discount will be given, aetna is unable to guarantee any level of discount under this program.

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全国质量保证委员会(ncqa)

这是一个独立的非盈利组织. 它也被称为ncqa. ncqa有一个官方的认可程序. It measures how well a health plan:

 

  • 管理其护理服务系统
  • 改善成员的医疗保健
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National Medical Excellence Program®

This is an aetna program. 它帮助成员获得覆盖的治疗:

 

  • Solid organ transplants
  • Bone marrow transplants
  • Some other rare or complex conditions

这些服务必须由网络设施来完成. 他们必须在这些领域有经验.

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nausea

这是一种胃里不舒服的感觉.

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ncqa

也被称为 National Committee for Quality Assurance. 这是一个独立的非盈利组织. ncqa有一个官方的认可程序. It measures how well a health plan:

 

  • 管理其护理服务系统
  • 改善成员的医疗保健
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必要的

Health plans usually pay only for care that is necessary. 他们通过使用医疗标准或研究来确定哪种护理最有效. 护理可以指保健服务或用品. 这也被称为医疗必需品,医疗必需品服务或医疗必需品.

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网络

一个网络是一组卫生保健提供者. 它包括医生、牙医和医院. 该网络中的卫生保健提供者与卫生计划签订合同,以提供服务. Usually, the network provides services at a special rate. 在一些健康计划中,当人们在网络中获得医疗保健时,他们得到了更多的保险.

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非癌变

This refers to something that has no signs of cancer.

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Noncontributory

This is the cost of a group insurance plan that is paid by an employer. It can be part of the cost or can be the entire cost.

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Non-occupational disease

This describes a disease not caused by a job or in any act related to a job.

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Non-occupational injury

This is an injury not caused by a job or an act related to a job.

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Nonparticipating provider

这是一个没有健康计划合同的医疗保健提供者. People might pay more when they visit this kind of doctor, 医院或其他卫生保健专业人员. This may also be referred to as out of network or nonpreferred.

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非处方的

This means a person can buy a drug without a doctor's prescription.

O

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奥巴马医改

也被称为 the Affordable Care Act. 这是一个你.S. law that changed health care and the health insurance system.

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工伤或职业病

This is an injury or disease caused by doing a job. In most states, this is covered by workers' compensation.

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Occupational therapy

People can lose some skills because of an accident or illness. These skills include walking, eating, drinking, dressing and bathing. 这种治疗有助于恢复技能.

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开放获取

Some health plans let members see a participating provider without a referral. In other words, they give open access. Also called direct access.

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开放登记

People make choices about their health plan coverage during this period. 他们选择的是明年的保险.

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开放的规定

Some prescription benefits plans cover all eligible prescription drugs. This means they have an open formulary. 在这些计划中,人们可能对首选药物清单上的药物有较低的共付医疗费. They might have higher copays for drugs that are not on this list.

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最优

This means most favorable or best.

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oral

也就是用嘴.

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口腔颌面外科医生

This dental surgeon treats in and around the inside of the mouth and jaws.

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Original 医疗保险 plan

也被称为

 

医疗保险:

 

这是原始医疗保险计划的一部分. 它由联邦政府管理. 它涵盖了以下方面的部分(但不是全部)开支:

 

  • 住院治疗在医院的住院治疗
  • 在专业护理机构接受医疗护理
  • 临终关怀
  • 家庭健康护理

该计划有其局限性. People also must pay deductibles, copays and other costs.

 

或者医疗保险B部分:

 

这是原始医疗保险计划的一部分 managed by the federal government. 人们报名参加这个计划. 他们通常每月为该计划支付保险费. 它涵盖了:

 

  • 医生提供的必要服务
  • 在医院接受门诊治疗

它也为一些支付一些费用:

 

  • 物理治疗
  • Occupational therapy
  • 家庭健康护理
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牙齿矫正医师

This is a type of dental specialist. 这名专家发现、预防和纠正牙齿在上下腭中位置的问题.

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Other income benefits

残疾计划为因病或受伤而不能工作的人提供一种收入来源. 这些被称为收入福利. Income from other sources may reduce payments made under the plan. These are called other income benefits. 它们也被称为抵消或减少. Social Security 残疾 and workers' compensation are two examples. See "最低收益" and "Social Security 残疾."

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的网络

If you choose a doctor or other health care provider who is out of network, your aetna health plan may pay some of that doctor's bill. But it will pay less than if you get care from a doctor in our network. 如果你决定找一个不在正规的电竞竞猜软件网络内的医生,你会花更多的钱.

 

查看您的计划文件了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外的医疗. Or call 会员服务 at the phone number listed on your aetna 身份证.

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需要支付的费用

这些是会员必须支付的医疗费用. copays and deductibles are examples.

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Out-of-pocket maximum

这是一个健康计划成员必须为覆盖的服务支付费用的限制. 限额可以是一年或一美元的数额.

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门诊医疗

这是一个人在诊所、急诊室、医院或手术中心得到的护理. 这个人做完手术就回家了. There is no overnight stay.

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Outpatient procedure

Some procedures can be done in a hospital, surgery center or doctor's office. 这个人做完手术就回家了. There is no overnight stay. 这也被称为门诊手术.

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Over-the-counter drugs

These are drugs that can be bought without a prescription. They are not covered under most prescription benefits plans.

P

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姑息治疗

这是立即缓解疼痛的护理. 它不是一种疾病的最终治疗方法.

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Partial day treatment

This program provides treatment for mental health or substance abuse issues. 它在白天或晚上提供. 不需要过夜.

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部分残疾

这是指一个人生病或受伤. It stops the person from doing one or more job tasks. 这使得残疾人的收入只有残疾前的80%或更少.

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Participating pharmacy

This is a pharmacy that has a contract with a health plan. 它为计划成员提供保险处方. members might pay less for their prescriptions at this type of pharmacy.

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Participating provider

This is a doctor, hospital or other health care provider. 提供者与健康计划签订合同. The provider is part of the plan's network for covered services. People may pay less when they visit this type of provider.

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Patient-centered medical home (PCMH)

This is a team-based approach to providing health care. A single doctor and care team coordinate all of your care. They work with other specialists and hospitals as needed. A PCMH is used for both simple and complex medical conditions.

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pct

也被称为 primary care physician. This is a doctor who is part of a health plan's network. 这位医生是病人治疗的主要联系人. pcts give referrals for other care. 他们协调病人从专家或其他护理机构获得的护理. In some health plans, a person must choose a pct to coordinate care.

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pdp

也被称为 医疗保险处方药计划 or 医疗保险D部分. 这是一个可选的医疗保险计划. 它是独立于医疗保健计划的. 它为一些处方药提供保险. 它是通过一家私人公司提供的.

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儿科牙医

这位牙医为儿童治疗。. 有时这个牙医被称为儿科医生.

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未决的索赔

This is a medical claim that has not yet been approved or denied.

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养老金

这是雇员的退休基金. It is usually not taxed. An employer pays for or contributes to the fund as part of a benefits package.

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牙周疾病

This is a dental condition. It affects the gums and bones supporting the teeth. The disease is caused by bacteria that stick to teeth and teeth roots. If not treated, it can destroy the gums and supporting bone around the teeth. 它也被称为牙周炎.

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牙周病医师

This is a type of dentist. 这位专家预防、发现和治疗牙龈和支撑牙齿的骨骼疾病.

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永久性和完全残疾

Sometimes, a person becomes disabled and can never return to work. 这个福利为那个人提供报酬. 它弥补了一些损失的收入. 付款可以一次付清,也可以连续付清.

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永久部分残疾

这是一种伤害或疾病,使人们不能正常工作. It causes the person to lose income. This benefit repays some of the income that is lost.

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Personal health record

这是一个人的健康信息记录. 它可以包括索赔和其他健康历史. 它被存储在网上并在电脑上观看. A health plan can add to it. It might add medical claims received and doctor visit information. 人们还可以添加自己的信息. They might add information on family health or eating habits.

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药店

A pharmacy is a drug store.

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药店 and therapeutics committee

这是一群卫生保健专业人员. 医生,药剂师和其他人都在调查. The group advises a health plan company on safe and effective drug use. 它也帮助计划建立一个公式.

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药房元钱

This is a person's share for covered prescription drugs. It is paid to a participating pharmacy. It is a set dollar amount.

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Physical assistant (PA)

This is a person licensed to practice medicine as part of a team with doctors. 助理医师负责体检、开药、诊断和治疗疾病,并可能协助手术.

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生理反应

这描述了身体对某物的反应.

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物理治疗

This is care given to help improve part of the body. It helps ease pain and promote healing. It can also help prevent disability. 它被用来限制疾病的影响. 它也可以在生病、受伤或手术后使用.

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医生

This is a medical doctor.

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医生服务

医生在对疾病或受伤进行专业检查时所提供的普通和通常的专业服务.

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安慰剂

这是一种没有药物的物质. 它也被称为糖丸. It can be given to help people expect to feel better. 它通常用于检测潜在的新药和治疗方法如何发挥作用.

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计划文件

A plan sponsor gets important papers from a health plan. These are plan documents. They describe the details of coverage. 他们包括:

 

  • 集团的协议
  • 组策略
  • Certificate or evidence of coverage or certificate of insurance
  • 保险范围或福利概述
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计划排除和限制

These are legal conditions. They apply to health plans. They list specifically what is and what is not covered by the plan.

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计划最大

This is a limit on the dollar amount of benefits a health plan will play.

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计划赞助商

这是一个建立和管理健康计划或团体保险计划的小组. It can be an employer. It can also be a labor union, government agency or nonprofit group.

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Platinum health plan

See "Health plan categories."

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Point of service (pos)

这是一种健康计划. 它让成员看到参与的提供者. 他们也可以看到不参与的提供者. 在许多pos计划中, 使用转诊和看初级保健医生(pct)的成员得到了更多的覆盖. They may pay less for care. members can get care from a provider who is not a pct. 他们可能会支付更多的医疗费用.

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policy

也被称为 a contract. This is a legal agreement. It is between a customer (an individual or group) and an insurance plan. 它列出了该计划覆盖范围的所有细节.

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投保人

This is a person who has a contract with an insurance company.

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可移植性

这是投保人的合法权利. The person gets to keep group insurance as an individual policy. People don't have to prove they are in good health to keep the policy.

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pos

也被称为服务点. 这是一种健康计划. 它让成员看到参与的提供者. 他们也可以看到不参与的提供者. 在许多pos计划中, 使用转诊和看初级保健医生(pct)的成员得到更多的覆盖. They may pay less for care. members can get care from a provider who is not a pct. 他们可能会支付更多的医疗费用.

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ppo

也称为首选提供者组织. This is a type of health benefits plan. 会员可以选择任何医生. 他们不需要指定一个初级保健医生. No referrals are needed. members who go to network providers usually get more coverage. 他们可能会支付更少的服务费用.

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实践指南

These are for doctors. 它们描述了诊断和治疗疾病或损伤的最佳可能方法. They are based on medical research. 一些称之为:

 

  • 临床实践指南
  • 实践参数
  • 医疗协议
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Preauthorization or precertification*

这是一个重要的过程. It is approval a person gets for care before receiving the care. This helps people know if the care is covered by a health plan. 人们应该检查他们的计划,看看什么样的服务需要这个批准.

 

This can also be called:

 

  • 授权
  • 认证
  • 之前的授权

*在德克萨斯州, 这种批准被称为服役前使用审查,而不是根据德州法律定义的核查.

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Pre-disability earnings

This is how much money a person earned before a disability. It can be a weekly or monthly rate.

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Pre-existing condition

This is a health condition. It was diagnosed or treated before the date a health plan's coverage began.

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Preferred care provider

也称为参与提供者. This is a doctor, hospital or other health care provider. 提供者与健康计划签订合同. The provider is part of the plan's network for covered services. People may pay less when they visit this type of provider.

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首选药物列表

也被称为 formulary. This is a list of prescription drugs the health plan covers. It can include drugs that are brand name and generic. drugs on this list may cost less than drugs not on the list. 不同药物的保险金额不同. An open formulary provides a greater choice of covered drugs. 它也被称为首选药物列表.

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Preferred provider organization (ppo)

This is a type of health benefits plan. 会员可以选择任何医生. 他们不需要指定一个初级保健医生. No referrals are needed. members who go to network providers usually get more coverage. 他们可能会支付更少的服务费用.

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溢价

This is the amount paid to a health plan company for coverage. 一个人可以直接支付. Sometimes a person has a health plan with an employer. Then this cost might be shared between the person and the employer.

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保费豁免

这是合同中的一个短语. 这意味着保险公司可以为残疾员工提供人寿保险. 员工不支付保险费用.

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处方

医生开的药方就是处方. It is usually written. If it is a verbal order, it must be put in writing by the pharmacy.

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处方药

This is a type of medicine. It must be sold only with a doctor's prescription. 它与非处方药不同,非处方药无需处方即可购买.

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处方药计划(pdp)

这是任何帮助支付处方药的福利计划或保险计划.

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现行收费

你的健康计划将支付的金额的限制. 也被称为通常的,习惯的和合理的(ucr),习惯的和合理的,或合理的收费. 这个限制是基于aetna收到的数据. The data is based on what doctors charge for the health care service. We receive the data from Fair Health, an independent organization.

 

查看您的计划文件了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外的医疗. Or call 会员服务 at the phone number on your aetna 身份证.

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预防保健

This type of care is often covered in a health plan. It includes programs or services that can help people prevent disease. It may include yearly exams, shots and tests for some diseases. 这种测试有时被称为筛查.

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初级护理医生(pct)

This is a doctor who is part of a health plan's network. 这位医生是病人治疗的主要联系人. pcts give referrals for other care. 他们协调病人从专家或其他护理机构获得的护理. In some health plans, a person must choose a pct to coordinate care.

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Primary care provider

A health care practitioner who sees people that have common medical problems. This person is most often a doctor. 然而,初级护理提供者可以是医生助理或执业护士.

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之前的授权*

这是一个重要的过程. It is approval a person gets for care before receiving the care. This helps people know if the care is covered by a health plan. 人们应该检查他们的计划,看看什么样的服务需要这个批准. This can also be called:

 

  • Precertification
  • 授权
  • 认证

*在德克萨斯州, 这种批准被称为服役前使用审查,而不是根据德州法律定义的核查.

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Prior creditable coverage

This term means types of health coverage a person has had. 人们有时需要证明他们有这个,这样他们就可以被一个新的计划完全覆盖. 一些可接受的类型的例子如下:

 

  • 团体或个人保险
  • 医疗保险
  • 医疗补助计划
  • 军警人员的保健
  • A program of the Indian Health Service
  • 一个州健康福利风险池
  • 联邦雇员健康福利计划
  • A public health plan (any plan established by a state, the government of the United States, or any subdivision of a state or of the government of the United States, or a foreign country.)
  • Any health benefits plan under Section 5(e) of the Peace Corps Act
  • The State Children's Health Insurance Program (S-CHIP)
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私人费用计划

这是一种医疗保险优先计划. It is offered through a private health plan company. 一个人为医疗保险付保险费. Then, the person can go to any doctor or hospital that:

 

  • Is approved by 医疗保险
  • 接受计划的付款和其他条款
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进步

在医疗保健中,这指的是随着时间的推移而恶化的疾病或状况.

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预防

这是一项例行的卫生服务. 医生或牙医这样做是为了保持健康和防止疾病的传播.

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假肢器官

这是一个人造的身体部位. 它是用来替换身体中损坏、缺失或不能正常工作的部分. 它可以代替牙齿、眼睛、手臂、腿或手.

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镶牙专家

This is a type of dentist. This dentist restores or maintains dental health by replacing natural teeth. 一个人可能会去看这个假牙专家.

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提供者

健康计划经常使用这个术语. It means a licensed person or place that delivers health care services. Some examples are doctors, dentists, hospitals and more.

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供应商网络

也被称为 network. 一个网络是一组卫生保健提供者. 它包括医生、牙医和医院. 该网络中的卫生保健提供者与卫生计划签订合同,以提供服务. Usually, the network provides services at a special rate. 在一些健康计划中,当人们在网络中获得医疗保健时,他们得到了更多的保险.

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提供搜索

这是aetna的在线目录. It lists doctors and health care professionals in the network. 会员们用它来寻找住所附近的护理机构. The list has doctors, hospitals, dentists, pharmacists and more.

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《正规的电竞竞猜软件》(ACA)

This is also known as the Affordable Care Act or ACA. 它在2010年3月被签署为联邦法律. The goals are to help more people get health care coverage, improve care quality and efficiency, 并降低成本.

 

Learn more about the ACA

Q

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Qualified medical expenses (also known as eligible medical expenses)

These are costs paid for health care that people can deduct from their taxes. 如果这样做,他们肯定没有收到通过保险支付的费用.

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符合条件的事件

These are events that let members change their health benefits. Examples include death, job loss, divorce and marriage.

R

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放射治疗

这是一种治疗癌症的方法. High-energy rays damage cancer cells so they stop growing.

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合理的收费

你的健康计划将支付的金额的限制. 也称为通常的,习惯的和合理的(ucr),习惯的和合理的,或普遍的收费. 这个限制是基于aetna收到的数据. The data is based on what doctors charge for the health care service. We receive the data from Fair Health, an independent organization.

 

查看您的计划文件了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外的医疗. Or call 会员服务 at the phone number listed on your aetna 身份证. 

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合理的职业或工作

这是一个有报酬的职业或工作,残疾人可以通过培训或技能获得.

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公认的电荷

你的健康计划将支付的金额的限制. 也叫允许金额. If you choose to go out of network, 你的供应商可能不会接受这一金额作为全部付款,可能会要求你支付其余的费用. This is in addition to your plan's required copays and deductibles.

 

查看你的计划文档了解更多细节. 他们会告诉你正规的电竞竞猜软件如何支付网络外的医疗费用,以及正规的电竞竞猜软件如何计算公认的费用. Or call 会员服务 at the phone number listed on your aetna 身份证.

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Reconstructive surgery

外科手术为恢复功能和正常外观并纠正因出生缺陷造成的畸形而进行的外科手术, 创伤或医疗状况, 包括癌症.

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Recurrent disability

这意味着一个人会因为同样的原因获得不止一次的残疾津贴. There is a period in between when they are back at work. There is a limit to how long this time period can be.

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推荐

这是你的医生给你的表格,这样你就可以从专家或卫生保健机构得到治疗. It may be written or sent by computer.

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Rehabilitation program

这是一个帮助人们改善健康的项目,这样他们就可以重返工作岗位. 使用身体、心理和职业培训.

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Rehabilitation services

康复服务帮助你恢复或发展日常生活的技能和功能. They include short-term services prescribed by your physician, 如物理, 职业或语言治疗.

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报销

这是你从你的健康计划中得到的钱,你支付给你的医生的费用.

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相关的缺席

This is when a worker is out of work two different times or more. The worker is out for the same health problem each time.

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reline

This is when a dentist resurfaces part of a denture to make it fit better.

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这是指保单继续生效,但条款改变了,比如新的费率.

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暂息护理的

这种照料使家庭从持续照料的职责中得到短暂的休息.

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退休人员

这是一个退休的员工. 要退休,雇员必须符合雇主关于最低年龄和服务年限的规定.

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退休人员 reimbursement account (rra)

This is a type of account people can use after they have retired. It can help pay for health plan premiums and medical costs. 雇主把钱存入帐户. Balances roll over year to year, per employer rules.

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退休的规则

This rule sets the benefit amounts that retired workers can get.

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高额(环球套票)的激励

This lets workers who were disabled return to work part time. 如果他们的残疾津贴和工资低于他们残疾前的收入,他们可以返回.

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This is a policy that is separate from the main policy. 它有影响主要政策的变化.

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risk

这是损失的机会或可能性.

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翻转功能

This lets a person carry forward or "roll over" any balance in a health fund. The amount can be used to pay for health care costs in future years.

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rra

也被称为退休人员补偿帐户. This is a type of account people can use after they have retired. It can help pay for health plan premiums and medical costs. 雇主把钱存入帐户. Balances roll over year to year, per employer rules.

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也被称为重返工作的激励. This lets workers who were disabled return to work part time. 如果他们的残疾津贴和工资低于他们残疾前的收入,他们可以返回.

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Rx

This is a common symbol. It means prescription or pharmacy.

S

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工资延续

This is for when employees are disabled for a short time. The employer pays part or all of the employees' salary.

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Schedule of benefits and exclusions

This list states what a policy does and does not cover.

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第二个意见

这是另一个医生的意见. 在你第一次去看医生的时候,你收到了医生的意见. 这给了你一个比较这两种观点的机会. Then you can decide how you want to treat your problem.

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自筹资金计划

也被称为自我保险计划. 这是一种由雇主承担大部分或全部福利申请费用的计划. 福利公司负责支付. 但是雇主是支付索赔的人. These plans are often more flexible for the employer. That is because the employer is often not subject to state law requirements.

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Self-insured employer

This is an employer who pays benefit claims for employees. 雇主承担了福利索赔的大部分或全部风险. 福利公司负责管理这些款项.

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自我保险的计划

这也被称为自筹资金计划. 这是一种由雇主承担大部分或全部福利申请费用的计划. 福利公司负责支付. 但是雇主是支付索赔的人. These plans are often more flexible for the employer. That is because the employer is often not subject to state law requirements.

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sep

也被称为特殊选举时期. 这是为有医疗保险计划的人准备的. 这是一个他们可以改变他们的福利的时候,因为他们的生活发生了变化. Examples are moving out of a plan service area, or being able to get 医疗补助计划. If nothing in their life changed, they must wait for an enrollment period.

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服务区域

这是健康计划服务的区域. It is where the plan is licensed to accept members. It is also where a network of doctors exists to give health care services.

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短期残疾(免受std)

This pays part of a worker's pay while out of work. 此人必须因与工作无关的疾病或受伤而短期失业.

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Short-term health insurance

This is a type of health care plan that fills gaps in a regular plan. 当你在找工作、搬家或出国时,它会给你带来好处. It usually lasts for one year or less. 而且通常不能续签.

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This is a condition for which you would need medical care.

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银健康计划

See “Health plan categories.”

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熟练护理机构(snf)

这是一个为不需要住院的人提供护理的地方. 这是许可的. 它也提供康复和其他护理. 它不包括疗养院,也不包括那些需要日常生活帮助的人.

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小企业健康保险

This is health insurance for companies that have 2 to 50 employees. 这些计划帮助雇主节省税款. 他们还帮助员工节省保险费.

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smi

See "Supplemental medical insurance." This is also called 医疗保险B部分. 这项保险包括基本的医疗需要. It is paid by both the insured person and the government.

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snf

也被称为专业护理机构. 这是一个为不需要住院的人提供护理的地方. 这是许可的. 它也提供康复和其他护理. 它不包括疗养院,也不包括那些需要日常生活帮助的人.

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snp

也被称为 a special needs plan. 这是医保优势hmo或ppo计划. It is for smaller groups of people who get 医疗保险. There are three types of these plans. The first type is for those who receive both 医疗保险 and state 医疗补助计划. The second type is for those who live in a long­term care home. The third type is for those with a condition that is disabling.

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Social Security retirement benefits

This is a retirement program run by the government. 它是通过联邦所得税支付的. 它每个月给美国人一张支票,根据他们的工作年限和他们一生中挣到的钱.

 

一个人可以在62岁时开始领取保险金. 一个人挣的钱越多,社保支票的金额可能就越高. If they have earned less, their check amount may be lower.

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Special benefit networks

These are groups of doctors, specialists or health centers. They give care for special services. For example, services could be for mental health and drug abuse.

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特别选举期(sep)

这是为有医疗保险计划的人准备的. 这是一个他们可以改变他们的福利的时候,因为他们的生活发生了变化. Examples are moving out of a plan service area, or being able to get 医疗补助计划. If nothing in their life changed, they must wait for an enrollment period.

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Special needs plan (snp)

这是医保优势hmo或ppo计划. It is for smaller groups of people who get 医疗保险. There are three types of these plans. The first type is for those who receive both 医疗保险 and state 医疗补助计划. The second type is for those who live in a long-term care home. The third type is for those with a disabling condition.

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专家

This is a doctor who is trained to give care in a specific medical area. The doctor's focus could be on a disease, part of the body or age group.

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Speech-language therapy

This is treatment to improve a person's speech or language skills. 这个问题可能是从出生开始的. 但也可能是某种疾病造成的, an earlier medical treatment or a time when the person got hurt.

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员工模型

This is a type of hmo plan. 医生是卫生组织的雇员. This is different from an independent practice association (ipa) hmo. In an ipa-model hmo, the doctors are not employees of the hmo.

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State insurance department

这是一个制定州保险法的机构. It also makes sure insurance companies follow the laws in the state.

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State-mandated benefits

这些都是一个国家在政策中需要的福利. If the benefit is not in the policy, it cannot be sold in the state.

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免受std

也被称为 short-term disability. This pays part of a worker's pay while out of work. 此人必须因与工作无关的疾病或受伤而短期失业.

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一步的治疗

This is a way that a health plan controls drug costs. 这意味着,在该计划支付特定品牌药物的费用之前,一个人必须尝试某些药物. 第一批药物通常是仿制药,价格较低.

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止损范围

This protects employers who take on most of the risk of a health plan. An employer can buy this to avoid having to pay for large health claims. 如果医疗费用超过合同中所列的金额,该计划将支付剩余的费用.

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订阅者

这是一个参加健康计划的人. If it's a family health plan, the subscriber add people to it as dependents. Those people must be eligible to join. Some health plans also use the word enrollee for this term.

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Successive disabilities

This is when a person is disabled two or more times. 每一次都是由于相同的条件. Or each time can happen because of a related condition. Each episode is separated by a time period that is stated in the contract.

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福利及保险范围摘要(SBC)

这份文件告诉你健康计划涵盖的范围以及你要承担的费用份额. For example, it lists your deductible, copay and out-of­pocket limits. 所有计划必须为SBC使用相同的格式,因此您可以轻松地比较计划. You can check this document when shopping for or enrolling in a plan. 或者你可以随时向你的保险公司或团体健康计划索取一份副本.

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Supplemental life insurance

这是额外的人寿保险. 雇员可以购买这个,以获得比雇主提供的基本金额更多的钱.

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Supplemental medical insurance (smi)

This is also called 医疗保险B部分. 这项保险包括基本的医疗需要. It is paid by both the insured person and the government.

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遗属抚恤金

This has to do with a disability plan. It pays money to a living person if the person who holds the policy dies. 保单上有活人的名字.

T

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远程医疗

This allows doctors to treat patients without an office visit. 他们用视频、电话或电子邮件交谈. This can help improve care. 偏远地区的病人可以从远方的医生和专家那里得到帮助.

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临时部分残疾

这是一项员工福利. 该公司为那些重返工作岗位但不能从事正常工作的员工提供有限的薪酬. Only workers who were injured on the job can receive this pay.

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Temporary total disability

这是一项员工福利. It offers limited pay to employees who cannot work at all. Only workers who were injured on the job can receive this pay.

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颞下颌关节(颞下颌关节)

This is a joint that connects the jaw to the skull. There are two of them. 两只耳朵前各坐一个.

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颞下颌关节紊乱症(tmd)

This includes pain and other symptoms affecting the head, jaw and face. 它是由于下颌关节和控制它们的肌肉不能正常工作而引起的.

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定期人寿保险

这是一种人寿保险. It is in effect only during the period, or term, for which premiums are paid. 它不会增加现金价值.

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三级护理

这是专门的医疗服务. 它涉及复杂的程序. 人们通常需要这种护理很长一段时间. 专家s in state-of-the-art medical centers give the care.

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tmd

也被称为颞下颌关节紊乱. This includes pain and other symptoms affecting the head, jaw and face. 它是由于下颌关节和控制它们的肌肉不能正常工作而引起的.

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tmj

也被称为 temporomandibular joint. This is a joint that connects the jaw to the skull. There are two of them. 两只耳朵前各坐一个.

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完全残疾(任何职业)

这意味着一个人不能从事任何职业. 这是因为疾病或受伤. 它是由工作经验、工作历史或就业市场等因素决定的.

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完全残疾(自身职业)

This means you are unable to perform your own occupation for any employer. 它可能因疾病或受伤而发生.

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传统的计划

也被称为赔偿计划. 这是一种健康计划. members can get care from any licensed doctor or hospital. They get the same level of benefits no matter who they see. 没有网络. The plan pays a percentage of each covered health care service. These plans often have deductibles, coinsurance and certain benefit maximums.

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可转移技能分析

这个测试可以帮助人们在无法胜任当前工作的情况下找到一份新工作. 这可能是因为疾病或受伤. 雇主看重的是员工的技能. Skills from past jobs, education or other activities are reviewed. 然后将这些技能与工人可能能够胜任的职位相匹配.

U

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ucr

又称平常、习惯和合理. This is a limit on the amount your health plan will pay. Also called customary and reasonable, reasonable or prevailing charge. 这个限制是基于aetna收到的数据. The data is based on what doctors charge for the health care service. We receive the data from Fair Health, an independent organization.

 

查看您的计划文件了解更多细节:您的健康计划文件将告诉您正规的电竞竞猜软件如何支付网络外的医疗. Or call 会员服务 at the phone number listed on your aetna 身份证.

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发现服务

这些也被称为排除. 它们是健康计划不包括的特定条件或服务. They are listed in the plan documents. Check to see what is not covered before enrolling in a plan. Ask the plan or your employer for a copy of the plan documents.

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承销

This process helps assess the costs of insuring potential members. 它被用来决定谁有资格获得保险. 可能会问一些医学问题. 可能需要进行健康检查. 费率水平和保费将根据结果而定.

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紧急护理中心

These centers can treat urgent, but non-life-threatening medical issues. A few examples are sprains, fractures and minor burns.

 

Urgent care clinics are a convenient option to the emergency room. 他们配备了护士和医生. 你少等. 你不需要预约. 许多学校一周七天营业. And you usually pay less.

 

如果你有危及生命的医疗问题,一定要先去当地的急诊室.

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Usual, customary and reasonable (ucr)

你的健康计划将支付的金额的限制. Also called customary and reasonable, reasonable or prevailing charge. 这个限制是基于aetna收到的数据. The data is based on what doctors charge for the health care service. We receive the data from Fair Health, an independent organization.

 

查看你的计划文档了解更多细节. Your health plan documents will tell you how we pay for out-of-network care. Or call 会员服务 at the phone number listed on your aetna 身份证.

V

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Vocational evaluation

This helps rate how willing and able a person is to return to work. It also shows how well the person will relate to managers and coworkers. 一种正式的方法是使用标准化测试和直接观察工人完成工作任务. 这通常在康复中心进行. An informal one is an interview usually done by a private job counselor.

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自愿的计划

这些是雇主提供的团体福利. 他们的工资完全由员工支付.

W

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无预约诊所

这是医疗中心. 你可以在很多超市和药店找到它. 一家诊所治疗小病和小伤. 它还提供健康筛查和疫苗. The clinic is often open evenings, weekends and holidays. When you can't see your regular doctor, a walk-in clinic can be a good option.

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W-2

这个表格是用来向美国国税局(IRS)报告个人收入的.

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每周的好处

这是一名员工在因残疾而失业时可以得到的钱. 它是每周支付的金额. 这取决于团体短期残疾计划的保险单或计划文件的条款. 完全保险公司使用的政策. 自我保险公司使用计划文件.

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好的婴儿护理

This is the routine care a child needs through the age of 8. It includes checkups, tests and shots.

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好照顾孩子

也被称为婴儿护理. This is the routine care a child needs through the age of 8. It includes checkups, tests and shots.

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好女人照顾

This is the regular care a woman needs. 它包括产科医生/妇科医生的检查和定期怀孕护理.

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健康计划

这些项目帮助人们保持健康. 它们可能包括预防疾病、保持健康和照顾自己健康的方法. 他们向人们展示更健康的生活方式.

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工作调整

This can help workers improve their skills and attitude on the job. 工人们可以得到正式的咨询. Or they may be supervised while doing job tasks in a rehabilitation center. This is often used with workers who have not worked for a long time. It is also used with people who have learning or psychiatric problems.

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加工硬化

工人们在接受物理治疗后回到工作岗位之前进入这个项目. They stay in it for two or four weeks. It helps improve physical abilities by using actual work tasks. 只有员工有动力并准备好重返工作岗位,他们才能启动这个项目. A job must also be available for them. 这个工作必须是开放的,这样他们就不会失去在这个项目中获得的技能和能力.

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Workers' compensation

这包括工人在工作中受伤. 根据这项法律,这些工人领取医疗费用和残疾津贴. 它在所有50个州,美属萨摩亚,关岛,波多黎各和美国.S. 属维尔京群岛.

X

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x - ray

This is a picture that can show bones and other internal parts of the body. 它被用来帮助诊断某些疾病.

Y

Z

电竞竞猜比较正规的

aetna是一个或多个aetna集团公司提供的产品和服务的品牌名称, including aetna Life Insurance Company and its affiliates (aetna).

Health benefits and health insurance plans contain exclusions and limitations.