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Glossary Of Health Care Coverage Terms

The following terms may help you review and understand the sections containing financial information.

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) lets you keep your health plan for a certain amount of time after you leave a job. It is available only if you had a health plan at your old job, and you will pay for the coverage you receive. (COBRA applies to most employer sponsored health care plans.)

Customary charges and exclusions

Your plan may base coverage on what is considered a reasonable and customary charge for the service. If your provider's charges are over this amount, then you may be responsible for the balance.

Experimental treatment

A type of treatment that is still under medical study. Many health-care plans will not pay the costs of experimental treatments.

Medicaid

A government program that pays the cost of medical care for low-income people with few assets. The income level is set by the state you live in. Not all doctors and hospitals accept Medicaid patients.

Medicare

A government program that pays for medical treatment for some groups of people. You qualify if you are older than 65 and retired. You also may qualify if you are younger than 65 and meet the criteria specified by Medicare. Many doctors and hospitals accept Medicare.

Pre-existing condition

A health condition that you had before you became covered by a medical plan. If you have a pre-existing condition, you may have to wait before your plan will pay for treatment of that condition.

Social security disability insurance (SSDI)

A government program that pays benefits if you become disabled. You must meet Social Security's definition of disability.

Standard of care

An accepted mode of treatment for a given disease or condition.

Supplemental security income (SSI)

A needs-based government program that guarantees a monthly income for individuals who are classified as disabled and who have limited income and assets.

Tax-exempt organization

Section 501(c)(3) of the Internal Revenue Code. This designation states that an organization must meet the criteria of the IRS to be exempt from federal income tax. Donations to such an organization are tax deductible.

Portions of the Glossary of Health Care Coverage Terms - Copyright © 2003 National Endowment for Financial Education. All rights reserved. Used with permission. Excerpted from Mapping the Maze: A Personal Financial Guide to Stem Cell Transplant.

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