Content Overview 
- Adverse Determination
- Annual Limits
- Case Manager
- Certificate of Creditable Coverage
- Coordination Of Benefits
- Co-Insurance
- Co-Pay
- Covered Charges
- Department Of Insurance
- Deductible
- Eligibility
- Experimental Treatment
- Explanation Of Benefits
- Extensions
- Fee-For-Service (Indemnity)
- Formulary
- Lifetime Limits
- HMO
- Medical Necessity (Medically Necessary)
- Out Of Network
- Out-of-Pocket Maximum (also known as "Stop Loss" or "Cap")
- Palliative Care
- POS
- PPO
- Renewability
- Pre-Existing Health Condition
- Stop Clause (also known as "Stop Loss Clause")
- Underwriting (What It Is And How It Works)
- U.S. Department Of Labor
- Usual, Customary and Reasonable "(UCR")
- Utilization Management
Glossary of Health Insurance Terms To Know
Case Manager
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Generally speaking, a case manager is a person who works to promote quality outcomes that are also cost-effective.
A case manager who works at a health insurance company may also help educate patients about subjects such as the following:
- What is covered and what is not covered by your health insurance.
- How to maximize use of your policy.
- How to get the medical care you need.
A case manager may also:
- Help coordinate medical professionals when necessary
- Work within the company to help bend rules when possible. For example, if your policy covers hospitalization, but not home care, a case manager can help argue on your behalf that the company should pay for much less expensive home care instead of insisting that you enter the much more expensive hospital for treatment.
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