What does ov stand for on insurance card

Starting in , if an employer with at least 50 full-time-equivalent employees doesn't provide affordable health insurance and an employee uses a tax credit to help pay for insurance through the Health Insurance Marketplace, the employer must pay a fee to help cover the cost of tax credits. Some benefits will be included in every health plan.

Beginning in , most insurance plans you can choose from — whether you buy on the Health Insurance Marketplace or go directly to the insurance company of your choice — will include many benefits that are meant to make sure basic health concerns are covered. For example, preventive care screenings and annual wellness exams are covered with any plan you buy. An EOB is created after a claim payment has been processed by your health plan. It explains the actions taken on a claim, such as the amount that will be paid, the benefit available, discounts, reasons for denying payment and the claims appeal process.

EOBs are available as a paper copy or electronically. Health care coverage for a primary policyholder called a "subscriber" and their spouse and any eligible dependents.

The income level of an individual or household, issued annually, used by the Department of Health and Human Services to determine eligibility for certain programs and benefits. FPL will be used to determine the amount of tax credit you qualify for to offset the cost of buying health insurance.

A prescription drug that is the generic equivalent of a brand name drug listed on your health plan's formulary and costs less than the brand name drug.

A health plan that was in place when the Affordable Care Act was passed into law in A grandfathered plan is exempt from some requirements of the law. The grandfather rule allows businesses and families to keep the plan they have, if they wish to.

A group of people covered under the same health plan and identified by their relation to the same employer or organization. A requirement under the Affordable Care Act that health insurers must permit you to enroll in some form of insurance coverage regardless of health status, age, gender or other factors. The Health Insurance Marketplace, or Health Insurance Exchange, is a federal government website where you can shop, compare and buy plans offered by participating health insurance companies in your area.

You can access the Marketplace at Healthcare. A type of health plan that provides health care coverage to its members through a network of doctors, hospitals and other health care providers. An HMO may cost less than other plans but has some limitations. When you visit a doctor or go to a hospital, you can pay for qualified expenses from your HSA. Only certain plans meet the high deductible amounts needed for you to be able to use your HSA.

A federal law that outlines the rules and requirements plans must follow to provide health care insurance coverage for individuals and groups. The most you have to pay for covered services in a plan year other.

After you spend this amount on deductibles, copays and coinsurance, your health plan pays percent of the costs of covered benefits. For plans that cover more than 1 person, individual out-of-pocket maximums counts toward the family out-of-pocket maximum. Once the family out-of-pocket maximum is reached, the plan pays percent of the cost of covered benefits for everyone on your plan.

The out-of-pocket maximum doesn't include your monthly premium payments or anything you spend for services your plan doesn't cover. Starting January 1, , employers can offer their employees an individual coverage Health Reimbursement Arrangement HRA instead of a traditional group health plan. This type of account may help reimburse qualifying health care expenses. As examples, these expenses could be monthly premiums and out-of-pocket costs, such as copays and deductibles.

Health care coverage for an individual with no covered dependents. Also knows as individual coverage. Infusion drug treatments are often used for chronic "maintenance" conditions like asthma, immune deficiencies or rheumatoid arthritis. The drugs are often covered under your health plan's medical benefit, not the drug benefit.

Where you get this care could change your out-of-pocket costs. Services provided by a physician or other health care provider with a contractual agreement with the insurance company and covered at a higher benefit level.

Services provided when a member is registered as a bed patient in a health care facility, such as a hospital. A cap on the total benefits you may get from your insurance company over the life of your plan for certain conditions. After a lifetime limit is reached, the health plan will no longer pay for covered services. There are no lifetime limits on essential health benefits, such as emergency services and hospital stays.

A joint federal and state funded program that provides health care coverage for low-income children and families, and for certain aged and disabled individuals. A medical cost-sharing group also called health-sharing ministries is a group of like-minded individuals that help each other pay their medical expenses. These groups are similar to a health plan.

However, instead of paying a monthly premium bill, contributions are made to a shareable account. This way, when a member is in need of health care funds, the shared money may be used to help cover the costs. A group of doctors and other health professionals that have a shared medical practice and contract with a health plan to deliver health care services to plan members.

The federal program established to provide health care coverage for eligible senior citizens and certain eligible disabled persons under age The person to whom health care coverage has been extended by the policyholder such as their employer or any of their covered family members.

Sometimes referred to as the insured or insured person. A healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee. Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses.

Allows members to save money into tax-advantaged accounts. Qualified contributions made to HSAs are tax-deductible, and funds withdrawn to pay for qualified medical expenses are tax-free. A cost containment program that recovers money for healthcare where primary responsibility does not exist because of another group health plan or contractual exclusions. Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance.

A type of Health Benefit Plan that allows members to go outside the network for non-emergency care, but may result in a lower level of benefits being paid by the Health Benefit Plan.

Established by the Balanced Budget Act, this program is designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs. Or, it can be paid to someone else after the death of an insured person.

Also known as Age Discrimination Employment Act. This is a U. It protects people against unfair treatment in the workplace due to age. A long-term disability plan provides a source of income if you cannot work because of illness or injury. This helps you maintain a percentage of what you earned before you became disabled. Adjustments are made over time to help protect against inflation. With no adjustment to your income, inflation would greatly reduce your buying power by the time you reached age Also known as accidental death and personal loss coverage.

This legal document tells your doctor what kind of care you want or do not want. It will be used if you are too sick to make medical decisions on your own. It is sometimes also called a living will. This is the name used for Aetna's consumer-directed health products. Each one comes with different types of funds to help members pay for their care. Take charge of your health plan with the Aetna member website.

Get all the plan information you need and find tools to help you manage your benefits. Register and log in today. This limits the length of time benefits will be paid. It applies to treatment for disabilities due to alcohol or drug abuse. A limit on the amount your health plan will pay. Also called the recognized charge. If you choose to go out of network, your provider may not accept this amount as payment in full and may bill you for the rest.

This is in addition to your plan's required copays and deductibles. Check your plan documents for more details: Your health plan documents will tell you how we pay for out-of-network care and how we calculate the allowed amount.

Also known as outpatient care. This is care a person gets in a clinic, emergency room, hospital or surgery center. The person gets the care and goes home.

There is no overnight stay. Also known as an outpatient procedure. Some procedures can be done in a hospital, surgery center or doctor's office. The person gets it done and goes home.

These are services provided to support your health care. Some examples include X-rays or lab tests. This is any type of job for which a person is qualified. A person can do the job because of schooling, training or experience. This is an important process. It is approval a person gets for care before receiving care. This helps people know if the care is covered by a health plan. People should check with their plan to see what kind of service needs this approval.

Doctors or hospitals sometimes do this. They bill patients to make up the difference between their usual fee and the amount they are paid by the health plan. Doctors and hospitals that work with Aetna will not do this. This is weight-loss surgery.

It is for very overweight people who haven't lost weight with diet and exercise. Doctors perform two types. One makes the stomach smaller. The other bypasses part of the intestine. Doctors or hospitals that do not charge the fees that Medicare approves sometimes do this. They bill patients to make up the difference between the approved fee and the top amount allowed by Medicare. The top amount is 15 percent more than the approved fee.

This is also called mental health. It describes a person's state of mind. Depression, eating disorders and substance abuse are conditions that fall under this term. This is the person you choose to receive your assets if you die. It can be the person you choose to receive payment from a life insurance policy after your death. This refers to medical services covered by your health plan. This word is also used to describe your health plan in general.

It can also mean payment received under a plan. This is the length of time that benefits will be paid. It applies to workers who are out on short-term or long-term disability. This is the maximum amount that may be paid under a benefit plan. There are several types of benefit maximums. A period of consecutive days during which medical benefits for covered services are available to the plan member. This describes health care practitioners who have met national standards for knowledge, skills and experience in a specialty area.

These practitioners include doctors, physician assistants, dentists, pharmacists and nurses. A drug sold by a drug company under a specific name or trademark. Brand-name drugs may be available by prescription or over the counter. Insurance brokers are also called agents. They are licensed by states as agents, brokers or insurance producers.

Insurance brokers help a person or business buy an insurance plan. The insurance plan can be bought through a health insurance exchange. Or it can be bought directly from an insurer.

Brokers represent the person or business buying insurance. However, they are usually paid by a commission from the insurer. This is a fixed amount of money doctors and hospitals get from health plans to serve plan members. They get this amount no matter how many patients they see.

This is the way health plans help people with complex care needs. Case managers help coordinate care to help people improve their health. This is a federal agency. It runs the Medicare program.

It also works with states to run the Medicaid program. This details the benefits provided by your health plan. It lists what is covered and what is not covered. You will get this document after you sign up for a plan.

It is approval a person gets for care before receiving the care. This is a way to decide if a worker is truly disabled. The terms of the policy are used to decide this. This is a cancer treatment. It involves chemical or biological drugs. These drugs are usually given through a vein.

This therapy is used to help treat the spine, joint pain and movement problems. A licensed chiropractor gives this care. Health insurers use these documents to explain the basis for coverage decisions for their members. In them, you can find details about how services are covered, or not covered. You can also find special guidelines that you may have to meet for a service to be covered.

Insurers use objective sources to make these decisions, like expert opinions or scientific literature. You may hear other terms that mean the same thing as CPBs. One example is "coverage determination guidelines. This is a request to be paid by a health plan for health services given. An example would be the claim your doctor sends to your health plan for an office visit.

It is also a request for payment under a disability or life insurance plan. A formulary is a list of prescription drugs the health plan covers. If the plan has a closed formulary, it only covers drugs that are on that list. It will not cover any part of the cost of non-formulary drugs.

However, in some instances, a plan may be willing to make an exception. To get one, you need to contact the plan and tell them why the drug is needed. COBRA is the continuation of coverage law. It requires most group health plans to offer a temporary continuation of group health coverage in certain circumstances. COBRA covers eligible employees, their spouses, former spouses and dependent children. If elected, it enables them to keep their coverage when it would otherwise be lost due to:.

This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum. Also known as cost of living adjustment. This is an optional benefit. It goes with some long-term disability plans. It raises the monthly benefit amount each year.

The person on disability gets more money based on the cost of living. These raises are given only for a set time period. This is the highest amount of life insurance you can get. It means you can have both basic and supplemental plans, but only up to this amount. This is when two people live together for a certain amount of time.

They think of themselves as married because of the time spent together. Some states agree and recognize them as married. This is a health problem that happens during pregnancy.

It is something that would not happen in a normal pregnancy. It can affect the baby, the mother or both. These are teeth that never existed in your mouth. This is a condition that existed at, or dates from, your birth. This plan helps you control more of your health benefit dollars. It includes a fund or account that can be used to pay for your medical expenses.

Most health funds allow unused dollars to be rolled over from year to year, for as long as you stay in the plan. Some plans allow the fund to go with you, even if you change jobs. This is a term for a new movement in health care. Its goal is to have everyone more involved in their own care. This means people will have more information to make better decisions about their health care. It includes knowing the real costs of health care and taking an active role in managing those costs.

This is a legal agreement. It is between a customer an individual or group and an insurance plan. It lists all details of the plan's coverage. This is a legal term. It is a customer an individual or group who buys an insurance plan from an insurer. This refers to a group health plan. It means costs are shared between an employer and its employees. This is an amount charged to change policies.

It must be paid when you change a group health plan to an individual policy. This means people can buy a policy on their own after they leave a group plan. It may be offered with certain health and life insurance plans. These rules are used to decide which plan pays first for people who have more than one plan. This helps coordinate coverage and allows claim information to be shared by the plans.

This way, the plans can avoid duplicate payments. This is the dollar amount you pay for health care expenses. In most plans, you pay this after you meet your deductible limit. For example, you pay a set dollar amount to your doctor for an office visit. Copays are also used for some hospital outpatient care services in the original Medicare plan.

In prescription drug plans, it is the amount you pay for covered drugs. Also known as copay. This online tool makes it easy to compare costs for office visits, procedures and more at different doctors and hospitals. The estimates are based on your health plan. The tool factors in your deductible, coinsurance and copays.

And it shows what Aetna will pay. This is also called the donut hole. It is the part of the Medicare plan where the member pays for prescription drugs. The plan does not pay. The gap occurs after you reach your initial coverage limit.

It lasts until the expenses you pay add up to a certain amount. These are services or supplies your health plan covers. They are eligible to be paid by your plan. This is a process. It is used to be sure doctors and hospitals meet certain standards.

It is also used for other health professionals and facilities. Also known as prior creditable coverage. This term means types of health coverage a person has had. People sometimes need to prove they have had this so they can be fully covered by a new plan. This applies to people who are eligible for Medicare. It is coverage that is at least as good as the Medicare drug plan. If you have such a prescription drug plan, you can stay in your plan.

You will not be charged higher fees if you switch to Medicare later. This is care that helps people with daily life activities. The person giving the care does not have to be trained in medicine.

This care may help people with walking, bathing, dressing and eating. Also called usual, customary and reasonable UCR , reasonable, or prevailing charge. The limit is based on data Aetna receives. The data is based on what doctors charge for the health care service. We receive this data from Fair Health, an independent organization. Check your plan documents for more details: Your health plan documents will tell you how we pay for out-of-network care.

This is the last day a person worked before becoming disabled. For long-term disability, it is the last day the person worked part of a day. This is the date a person becomes disabled. The person must meet the plan definition of disabled.

This is a place where people can get mental health care. They don't stay overnight. They visit the treatment provider as needed for care. Also known as date claim incurred. This is for disability plans. It is the date a person becomes disabled. This applies to life insurance.

It is the money that an insurance company pays when an insured member dies. This is what you must pay for health care before the Medicare plan begins to pay. This amount can change each year. There are many different types of these plans.

In them, employers give each worker a fixed amount of money. The worker can use the money for retirement, health or some other benefit.

When the plan is for health benefits, the money can be used to pay for health insurance or health services. This is a person who is covered by another person's plan. It can be a child, spouse or domestic partner.

You can put money into this account before taxes are taken. You can use the money later to pay for eligible childcare expenses. No taxes are taken out, so you lower your taxable income rate. The money does not build interest. It cannot be rolled over to the next year. Also, the money cannot be taken from one job to another. These are tests that a health care professional orders. The tests help see if a person has a condition or a disease. X-rays and ultrasounds are examples of these tests.

This is a type of health plan. The plan lets you go directly to a health care professional in the plan's network without a referral. Long-term disability LTD : Employees may have an illness or injury. They may not be able to work for a long time.

An LTD benefit through their employer helps protect them and their families from financial loss. It provides a source of income for a set time. This helps to maintain a percentage of the employees' pre-disability income. See "Other income benefits. Short-term disability: This pays part of workers' pay when they are out of work.

They must be out of work for a short time with an illness or injury that is not related to work. These are services and products. They help businesses track and manage when workers are out. This includes general absences and leaves of absence. This is a type of program that comes with some health plans. It is used to help people who live with a chronic illness. It helps members manage their health and prevent future problems.

Also known as date last worked. For short-term disability, it is the last day a person worked half a day or more. For Medicare patients: These are devices that doctors order for use in the home. They must be reusable. Some examples are walkers, wheelchairs or hospital beds. This means two people who live together but are not married. They are responsible for each other's well-being and finances. They may or may not be a same-sex couple. Also known as coverage gap.

Also known as a formulary. This is a list of prescription drugs the health plan covers. It can include drugs that are brand name and generic. Drugs on this list may cost less than drugs not on the list. How much a plan covers may vary from drug to drug. An open formulary provides a greater choice of covered drugs. It is also called a preferred drug list. These are groups of different drugs. Usually, the plans group the drugs by price.

Each group or tier requires a different copay. You might see the groups listed as generic, brand-name, or preferred brand-name drugs. A plan year is the 12 months during which your health plan is active and providing you with benefits. For example, your plan year can be from July 1 to June A premium is the required monthly payment you make to your health insurer for your health plan. If you have coverage through your employer, your premium cost is typically deducted from your paycheck each pay period.

A primary care provider, or PCP, is a health care provider that provides a broad range of routine medical services. A primary care provider refers patients to specialists, hospitals, and other health care providers as necessary. A primary care provider is usually a family or general practitioner, internist, or pediatrician.

Some types of health care plans require you to choose a primary care provider and get a referral before seeing a specialist. A provider is another term for a doctor, hospital, or another health care professional or facility that provides health care services.

A dermatologist, pharmacist, nurse practitioner, physical therapist, or midwife are all examples of providers. A referral is a recommendation from your doctor or health care provider to go see another health care provider for additional care, treatment, or a consultation. Many health plans require you to get a referral from your regular doctor or primary care provider before you can see a specialist.

Health care documents can be an alphabet soup of acronyms. Learn what the most common abbreviations mean so you and your employees can navigate your plans. Contact your broker or connect with a Cigna representative to learn more about how we can work together. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations.

For costs and details of coverage, contact a Cigna representative. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative.

This website is not intended for residents of New Mexico. Selecting these links will take you away from Cigna. Cigna may not control the content or links of non-Cigna websites. For the best experience on Cigna. Overview Medicare Coverage Options.

Broker Resources. Existing Clients Cigna for Employers. Existing Brokers Cigna for Brokers. Industry Insights. Authorization Authorization means approval. Beneficiary A beneficiary is a person who is eligible to receive health coverage under a plan. Benefit This is an important term to know. Claim A claim is a payment request from you or your health care provider to your health plan for covered services.