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Health Insurance Glossary

Mdash; [Also referred to as 'Usual and Customary Reimbursement or UCR.] The maximum amount of money that the health insurance provider will agree to pay for a specific medical service or procedure. Mdash; The insurance company or provider offering a health insurance plan. Mdash; A request made by the insured individual to the insurance company to pay for services that were administered by a medical professional. Explanation of Health Care Benefits (EOB). HMO - Health Maintenance Organization. Mdash; A ma...

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Any health insurance plan sold through. New York State of Health will need to. Include coverage for medical services in. The following 10 categories in. Accordance with the Affordable Care Act. Ambulatory patient services, such as. Doctor’s visits and outpatient services. Maternity and newborn care. Mental health and substance use. Disorder services, including behavioral. Rehabilitative and habilitative services. Preventive and wellness services and. Pediatric services, including oral and. Costs The 20% ...

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