GLOSSARY OF INSURANCE TERMS

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There are currently 13 terms in this directory beginning with the letter C.
C

Case Management
A planned approach to manage services or treatment for an individual with a serious medical problem. Its dual goal is to contain costs and promote more effective interventions to meet the patient’s needs.

Catastrophic Coverage
Coverage provided by the insurance company after the beneficiary has personally paid a certain amount of medical expenses out-of-pocket as predetermined by the payer.

Certificate of Coverage
A document that specifies the benefits issued to a member of group health insurance. This can change yearly depending on what an employer group elects to purchase.

CHAMPVA
A a health benefit program for the families of veterans with 100% service–connected disability and a surviving spouse or children of a veteran who dies from a service-connected disability.

Children’s Health Insurance Program (CHIP)
An insurance program jointly funded by a state and the federal government that provides health insurance to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but who cannot afford to purchase private health insurance coverage.

Claim
Information submitted to the insurer by the member or health care provider for the payment of services under a policy.

Co-insurance
An amount that an individual is required to pay out of pocket when they receive covered medical care that is a percentage of the total cost of that coverage.

Consolidated Omnibus Budget Reconciliation Act (COBRA)
A federal law that allows individuals leaving a company to continue the health insurance policy they had when employed.

Coordination of Benefits (COB)
A method of integrating benefits payable under more than one health insurance plan so that the insured’s benefits from all sources do not exceed allowable medical expenses.

Copay
A fixed-dollar amount a person is required to pay out of pocket when they receive covered medical care.

Cost Limit
A limit on the amount of money an insurance company will pay for benefits.

Cost Sharing
The term that insurance plans use to describe costs they “share” with the beneficiary, also often known as out-of-pocket costs.

Creditable Coverage
Drug coverage that pays, on average, as much as or more than the standard Medicare Part D drug coverage.
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