Allowable Charges: The maximum dollar amount that an insurance company will reimburse a provider for a specific service.
Biologically based mental health condition: The following disorders are considered biologically-based conditions: schizophrenia/psychotic disorders; major depression; bipolar disorder; delusional disorders; panic disorder; obsessive compulsive disorders, anorexia and bulimia. All other mental health conditions are considered to be non-biologically based conditions.
Co-pay: The specific dollar amount that you may be required to pay out-of-pocket for a specific type of service.
Co-insurance: The amount you are required to pay for covered healthcare services after you have satisfied any co-pay or deductible required by your health insurance plan.
Deductible: The amount you are required to pay out-of-pocket before the insurance company begins paying for your healthcare claims.
Insurance Charge: The amount paid to the health insurance company to maintain your coverage.
LOA: Leave of absence
Network: A group of doctors, hospitals and other healthcare providers contracted to provide services to insurance companies’ customers for less than their usual fees.
Out-of-Pocket Limit (OPL): The predetermined limited amount of money that an individual must pay out-of-pocket before an insurance company will pay 100% of healthcare expenses.
Patient Protection and Affordable Care Act (ACA): The Affordable Care Act (ACA) was enacted to increase the level of health insurance coverage to more Americans. There are a multitude of medical coverage requirements set forth in the law.
Reasonable and Customary Charge: The average fee charged by a particular type of healthcare provider within a geographic area.
SHC: Student Health Center