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It is important to read your policy thoroughly and understand what is covered. Since you will be responsible for paying medical bills that are denied by the insurance company, you should be familiar with what your policy actually does or does not cover. INSURANCE TERMS TO KNOW

Medical necessity refers to a determination that a treatment, test, or procedure is necessary to a person's health or to treat a diagnosed medical problem. Cosmetic procedures, for instance, are not covered under medical necessity provisions.

Co-payment is a specified dollar amount that the patient must pay to the physician or institution each time a service or visit is requested. Co-payments are usually required at the time of service and are set by the insurance company (typically an HMO or a PPO) as part of the policy.

Preexisting conditions are medical problems that an individual already has when he or she acquires an insurance policy. Preexisting conditions may not be covered by insurance policies.

Medicare is the health care plan for US citizens aged 65 years or older, persons with disabilities, and those with chronic renal failure. Most individuals need secondary insurance coverage to help with expenses not covered by Medicare. Recently, Medicare has developed prescription drug coverage to assist senior citizens with the cost of prescribed medications. Medicaid is health insurance for persons with very low incomes and for the disabled (if they do not qualify for Medicare). There are strict criteria for Medicaid qualification in each state.

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