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Individual Medical Insurance Glossary
Actual Charge – The amount charged by a physician for medical services performed.
Covered Expenses – Health care expenses incurred by an insured or covered person that qualify for reimbursement under the terms of a policy contract.
Covered Person – A person who pays premiums into the contract for the benefits provided and who also meets eligibility requirements.
Eligible Expenses – Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or "customary and reasonable charges."
Individual Contract – A contract made with an individual that covers that individual and perhaps also specified members of his family for benefits as described in the policy.
Medically Necessary – A service or treatment that is absolutely necessary in treating a patient and which could adversely affect the patient's condition if it were omitted.
Office Visit – Services provided in the physician's office.
Preexisting Condition – A medical condition that existed prior to the effective date of a policy. In many Health Policies these are not covered until after a stated period of time has elapsed, if at all.
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