Health Care Terms
Learn what the terms mean that your provider uses. There are even more word meanings in your member handbook.
| Term | Definition |
|---|---|
| Co-Payment (Co-pay) | The fixed amount you pay for a covered service. |
| Durable Medical Equipment | Supplies that can be used more than once for health services. |
| Explanation of Benefits (EOB) | A statement you may get that shows what health care services were billed to us and how they were paid. An EOB is not a bill. |
| Emergency Medical Condition | Transportation by ambulance of people who need emergency medical care. |
| Excluded Services | Health services that we do not pay for or cover. |
| Habilitation Services and Devices | Health care that helps you keep, learn, or fix skills and functioning for daily living. |
| Health Insurance | A contract that requires HAP CareSource to pay or all of your covered health care costs in exchange for a premium. |
| Home Health Care | The medical and health services that are given in your home by a provider. |
| Hospice Services | Services that give comfort and support for a person in the last stages of a terminal illness. |
| Hospitalization | Care in a hospital where you are admitted as a patient. |
| Hospital Outpatient Care | Care in a hospital. It often includes an overnight stay. |
| Medically Necessary | Care needed to diagnose or treat an illness, injury, condition, disease or its symptoms. |
| Participating Provider or Network Provider | A provider who has a contract with us to see HAP CareSource members. A non-participating provider has not signed a contract with us to see our members. |
| Plan | How your health care services are paid. |
| Premium | The monthly payment amount that we get per member through our contract with the state to provide services. |
| Prescription Drug Coverage | Drugs covered by your plan. |
| Prescription Drugs | Drugs prescribed for the cure, mitigation, or prevention of disease, or for health maintenance by a provider. |
| Primary Care Physician or Provider | Who you choose to be your personal doctor. They will treat you for most of your health care needs. |
| Rehabilitation Services and Devices | Help you keep, get back, or improve skills and functioning for daily life. |
| Skilled Nursing Care | Care from licensed nurses in your own home or in a nursing home. |
| Specialist | A doctor who focuses on a certain kind of medicine or has special training in a certain type of health care. |