Glossary of Terms- Behavioral Health Survey

Glossary of Terms- Behavioral Health Survey

The following is a glossary of terms that may help you answer questions for the survey:

Annual limit: A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year

Benefits: 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.

Claim: A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.

Copay: A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Deductible: The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

Inpatient care: Health care that you get when you're admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.

Out-of-pocket costs: Your expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

Outpatient care: Care where you go home after your appointment or treatment; you do not stay overnight.

Partial hospitalization: Care where you go home after daily/evening programs over weeks or months.

Primary care: Health services that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with you and advise and treat you on a range of health related issues. They may also coordinate your care with specialists.

Prior approval: Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.

Residential treatment: Safe, structured environments in which you are removed from stressful circumstances that promote or fuel the urge to use.

Specialty care: Services provided by clinicians who are educated and licensed to treat specific conditions.