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The maximum dollar amount set by a managed care plan, limiting the total amount the plan must pay for all healthcare services provided in a year.
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Claims are submitted to the managed care plan and include an itemized statement of the cost of each of the healthcare services provided by a hospital, physician, or other provider. The agents at our New Port Richey insurance agency help our clients with claim processing.
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The specified dollar amount that an insurance plan member must pay at the time the service has been rendered.
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A flat amount a group or individual plan member must pay before the insurer will make payments.
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A prepaid health plan that cover doctors' visits, hospital stays, emergency care, surgery, preventive care, checkups, lab tests, X-rays, and therapy. In a HMO, one must choose a primary care physician to coordinate all care and make referrals to any specialists that may be required. In a HMO, one must use the doctors, hospitals, and clinics that participate in your plan's network.
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A HSA is a tax-advantaged savings account for health care services. Our New Port Richey insurance office offers HSA plans for groups and individuals.
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A health plan that sets a high deductible before benefits will be paid. Once the deductible is reached, the plan pays all costs up to the annual maximum benefit amount.
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Health insurance coverage for expenses associated with hospitalization, surgery, and/or medical conditions requiring a broad range of medical supplies and services.
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A federal and state health insurance program for low-income individuals that meet eligibility requirements.
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A federal health insurance program for the elderly and disabled individuals.
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When something is “out-of-plan,” it usually refers to health care providers that are not participants in the insurance plan. It can also be services rendered by these providers may not be covered or covered at a reduced benefit.
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