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5
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Heath care service or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms, including habilitation, and that meets accepted standards of medicine.
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6
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Your share of the allowed amount for covered health care service. Your share is usually lower for in-network covered services
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10
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An amount you could owe during a coverage period for covered health care services before your plan begins to pay.
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11
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You share of the costs of a covered health care service, calculated as a percentage.
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12
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A contract that requires a heath insurer to pay some or all of your health care costs in exchange for a premium. May also be called a “policy” or “plan”.
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13
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A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment (DME) is medically necessary. Sometime called prior authorization, prior approval or precertification.
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15
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Health care services that your plan doesn’t pay for or cover.
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17
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Health care services that help a person keep, get back, or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt, or disabled. These services may include physical and occupational therapy,
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18
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Tests to figure out what your health problem is.
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19
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Drugs and medications that by law require a prescription.
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1
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A list of drugs your plan covers. A formulary my include how much your share of cost is for each drug. Your plan may put drugs in different cost sharing levels or tiers.
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2
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A written order from your primary care provider for you to see a specialist or get certain health care services. In many health maintenance organization (HMO’s), you need to get a referral before you can get health care services from anyone excep
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3
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AAA HMO Plan
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4
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A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your health insurer or plan for items or service you think are covered.
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5
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Yearly amount the federal government sets as the most each individual or family can be required to pay in cost sharing during the plan year for covered, in-network services.
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7
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The facilities, providers and supplies your health insurer or plan has contracted with to provide health care services.
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8
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AAA PPO Plan
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9
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A fixed amount you pay for a covered health care service, usually when you receive the service.
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14
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A provider focusing on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
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16
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Routine health care, including, screening, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems.
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19
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The amount that must be paid for your health insurance or plan. You and/or employer usually pay it monthly, quarterly, or yearly.
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