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Coordination of Benefits
The system for determining how claims are paid for patients covered under more than one
health benefit plan. Refer to your SPD for more information on how your plan coordinates benefits
with others.
Co-Pay
A flat fee you pay for a certain service or benefit, e.g. $10 for an office visit.
Covered Charge
A service or benefit eligible for payment; however, certain requirements or limits may apply.
Date of Service
The date on which a claim was incurred—necessary information for accurately calculating
when deductibles, benefit limits and out-of-pocket maximums are reached, if applicable.
Deductible
The amount the patient must pay before the plan pays benefits.
Discount
The difference between the amount the provider charges and the amount he or she agreed to
accept as payment in full.
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Duplicate Claim
A claim that has been submitted more than once for consideration by the plan. The claims
administrator should reject or deny duplicate claims to avoid duplicate payments.
Excluded Amount
The amount of a claim that is denied, typically for a service or benefit not covered under the
plan or provided in excess of plan maximums. Charges not covered under the plan do not count
toward deductibles or out-of-pocket limits.
Explanation of Benefits (EOB)
The statement produced by the benefit plan administrator showing how a claim was
processed.
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