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When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
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Organizing people together by age groups to calculate premiums.
- Browse Related Terms: Advanced Premium Tax Credit, Banding, Catastrophic Plan, Consumer Operated and Oriented Plans, dependent, Hardship Exemption, Health Savings Account (HSA), High deductible health plan (HDHP), High-Cost Excise Tax, Individual mandate, MinnesotaCare, Payment Frequency, Premium Tax Credit, Risk corridor
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A benefit level is a group of plans that have similar value. The groupings help you compare plans with similar covered benefits and costs to determine the plan that best fits your needs. The percentage represents the percent of your total benefit costs paid by the plan. You cover the rest.
- Browse Related Terms: Actuarial Value, Benefit Level, Coordination of Benefits, Dental Coverage, Excluded Services, Hospital Outpatient Care, Major Medical Health Insurance, Net Capital Gains, Subsidy, Total Cost Estimate (for health coverage)
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The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's coverage documents. In Medicaid or CHIP, covered benefits and excluded services are defined in state program rules.
Products and services covered under health plans.
- Browse Related Terms: Benefits, Centers for Medicare & Medicaid Services (CMS), Children's Health Insurance Program (CHIP), Department of Health and Human Services (HHS), Dependent Coverage, Disability, Domestic Partnership, Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT), Federal Poverty Level (FPL), fee, Health Coverage, Health Insurance Marketplace, Maryland Children’s Health Program (MCHP), Medicaid, Medicaid/Medical Assistance, Metal Level, State Health Insurance Assistance Program (SHIP), State Medical Assistance Office, Subsidized Coverage, TRICARE
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The generic version of more complicated medications.
- Browse Related Terms: Accreditation, Biosimilar Biological Products, Denial, Experimental and/or Investigational Medical Services, Not Yet Accredited (Health Plan), Pre-authorization, Preauthorization, Prior Authorization, Provider
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A board and care facility offers no nursing services. It is designed for people who are unable to take care of their day-to-day feeding, hygiene, and/or ambulatory needs. Sometimes called an "assisted living facility," their orientation is for provision of service over the "long term."
- Browse Related Terms: Acute Care Facility, Assisted Living, Board and Care Facility (Long Term), Hospice Care, Inpatient Care, Long-term Care, Skilled Nursing Care, Skilled Nursing Facility (SNF), Skilled Nursing Facility Care
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A drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand name drugs may be available by prescription or over the counter.
- Browse Related Terms: Annual Deductible Combined, Brand Name (Drugs), Donut Hole, Medicare Prescription Drug, Drug Formulary, Drug List, Essential Benefits, Excluded Drugs, Flexible Spending Account (FSA), Formulary, Generic Drug, Generic Drugs, Medicare, Medicare Part D, Medicare Prescription Drug Donut Hole, Name-brand Drug, Out-of-Pocket Estimate, Over-the-Counter Drug, Prescription Drug, Prescription Drug Coverage, Prescription Drugs
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An agent or broker is a person or business who can help you apply for help paying for coverage and enroll in a Qualified Health Plan (QHP) through the Marketplace. They can make specific recommendations about which plan you should enroll in. They’re also licensed and regulated by states and typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer's plans. Some brokers may only be able to sell plans from specific health insurers.
A person licensed by the State to sell insurance coverage with multiple health plans or insurers. The broker represents you and not the insurance companies. The broker helps you shop for the best policy. Note that no license is necessary to sell HMO products in California.
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All > Healthcare > Health Insurance
Insurance agents or brokers who have been certified by Maryland Health Connection can help you select and purchase health coverage.
- Browse Related Terms: agent, Authorized Representative, Broker, Brokers, Connector Organizations, Exchange, Marketplace, Small Business Health Options Program (SHOP), Uninsured
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- See Health Plan Categories
- Browse Related Terms: Bronze Health Plan, Cost Sharing Reduction, Gold Health Plan, Health Plan Categories, Platinum Health Plan, Silver Health Plan
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Every day that insurance companies are open for business, which excludes Saturday, Sunday, and state and federal holidays.
- Browse Related Terms: Business Day, Calendar Day, Contestability, Grace Period, Mandated benefit, Mandated Health Benefit, Plan Year, Policy Year, Waiting Period
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