Glossary

Refer to these health and medical terms to help you understand your Summary of Benefits and Coverage and other important plan documents.
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Insurance Terms
  • Behavioral Health

    Diagnosis and treatment of mental health and substance abuse disorders.

     
  • Benefit

    The dollar amount Quartz contributes toward the payment of covered health care services.

  • Brand Drug

    A prescription drug that is protected by a patent, supplied by a single company, and marketed under the manufacturer's brand name.

  • Covered Services or Covered Health Care Services

    Specific health care services covered under a member's health plan. Covered health services include primary care services, hospitalization, outpatient care, ambulatory and emergency care.

  • Certificate of Coverage

    The Certificate of Coverage is a document that defines services covered by a member's health plan. It also includes essential terms, conditions affecting eligibility, and services excluded from coverage.

  • Claim

    A request to Quartz seeking Quartz's payment toward the health care services covered under your health plan. You or your provider may submit a Claim.

  • Coinsurance

    The percentage of the charge for covered services that you have to pay after you pay the deductible.

    Example: If Quartz's allowed amount for an office visit is $100 and your coinsurance is 20 percent –

    After you've paid your deductible, you pay 20 percent of $100, or $20. Quartz pays the rest.

    If you haven't met your deductible, you pay the full amount of $100.

  • Copayment

    A fixed amount you pay for a covered health care service. For example, a copay of $20 means that when you go to the doctor and receive a bill that shows the cost of $130, you will only pay the fixed amount of $20 and Quartz will pay the rest.

  • Deductible

    A predetermined amount of money a member or family must pay before Quartz will make a payment toward covered services. Deductibles accumulate during your benefit period (usually a year) and reset at the end of the benefit period.

  • Dependent

    A person who receives health insurance through a spouse, parent or other family member.

  • Fee Schedule

    A Fee Schedule lists the maximum amount of money Quartz will reimburse a hospital or health care provider for covered services.

  • Formulary

    A list of prescription drugs covered by Quartz health plans. Your plan documents state the formulary that applies to your plan.

  • Generic Drug

    A chemically-equivalent copy designed from a brand-name drug whose patent has expired (typically less expensive and sold under the common name).

  • HMO (Health Maintenance Organization)

    A form of health insurance in which members prepay a premium for health services and which generally includes a defined set of services made available through a defined panel of physicians at a preset price.

  • HSA (Health Savings Account)

    A tax-advantaged way to save money for health care expenses. Members can establish a Health Savings Account when they have a High Deductible Health Plan (HDHP).

  • Member

    A person enrolled in a Quartz health plan.

  • Network

    A group of providers that have a contract with Quartz. Quartz contracts with health care providers to obtain lower prices for our members. By building a network of high-performing health care providers, Quartz seeks to make the best care available to our members at the lowest price.

  • Nurse Practitioner (NP)

    Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician. Nurse Practitioners cannot serve as a PCP for Quartz members, but are available for routine exams, urgent/problems visits, and follow-up care.

  • Out-of-Pocket Costs

    Your expenses for medical care that are not paid by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren't covered.

  • Participant

    A person who participates in the health benefit plan offered by their employer / plan sponsor.

  • POS (Point of Service)

    A managed care plan that offers coverage In-Network and Out-of-Network. Members pay lower out-of-pocket costs when they receive care from In-network providers.

  • PPO (Preferred Provider Organization)

    A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of providers. You pay less if you use providers that belong to Quartz's network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

  • Practitioner

    A person who supplies health care services, i.e., physician, psychologist, nurse practitioner.

  • Prior Authorization

    A request for prior authorization is submitted by members and providers. Quartz reviews the request and responds by letting the member and provider know whether the service, treatment, or supply is covered under the member's plan.

  • Provider

    A person or entity that supplies health care services. For example, Providers include pharmacies, hospitals or other health care facilities that provide services to members.

  • Schedule of Benefits (SOB) / Summary of Benefits and Coverage (SBC)

    An easy-to-read summary that shows health care services you may need and the benefit Quartz contributes toward paying the cost of those health care services.

  • Summary Plan Description (SPD)

    An easy-to-read summary that shows health care services you may need and the benefit your employer contributes toward paying the cost of those health care services.

  • Subscriber

    The person in whose name a health insurance certificate or insurance policy is held.

  • Usual, Customary and Reasonable (UCR)

    The amount covered by Quartz based upon the customary charges of all providers within a given geographic area for the same or similar health care service.

Medical Terms
  • Allergy and Immunology

    Diagnosis and treatment of allergic conditions and diseases of the immune system.

  • Anesthesiology

    Administration of anesthesia to achieve temporary, partial or complete loss of sensation to patient undergoing surgery.

  • Audiology and Speech – Language Pathology

    Diagnosis and treatment of hearing, speech and language disorders

  • Behavioral Health

    Diagnosis and treatment of mental or behavioral health problems such as depression, eating disorders, substance abuse or anxiety disorders. Practitioner types include psychiatrists, psychologists and counselors.

  • CNM (Certified Nurse Midwife)

    A person who assists women in childbirth.

  • CNP (Certified Nurse Practitioner)

    Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician.

  • CPNP (Pediatric Nurse Practitioner)

    Certified Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician, focusing on care of infants and children up to age 18.

  • Cancer

    See Oncology, Medical Oncology, Gynecologic Oncology and Radiation Oncology.

  • Cardiology or Cardiovascular Disease

    Diagnosis and treatment of diseases of the heart and blood vessels.

  • Chiropractic

    Treatment that utilizes the relationship between the musculoskeletal structures and functions of the body, particularly of the spinal column and the nervous system.

  • Critical Care Medicine

    Health care provided to a critically ill patient during a medical emergency or crisis.

  • DC (Doctor of Chiropractic)

    See Chiropractic.

  • DDS (Doctor of Dental Surgery)

    See Dentistry.

  • DO (Doctor of Osteopathy)

    Diagnose and treat diseases, injuries and disorders for people of all ages. Physician who has had four years of premedical education in a college or university followed by four years of medical school. Education includes training in musculoskeletal manipulation.

  • DPM (Doctor of Podiatric Medicine)

    See Podiatry.

  • Dentistry

    Care and treatment of the teeth and gums.

  • Dermatology

    Diagnosis and treatment of diseases and disorders of the skin.

  • Endocrinology, Diabetes and Metabolism

    Diagnosis and treatment of diseases and disorders of the endocrine glands (thyroid, pituitary, pancreas, ovaries and testes), including diabetes.

  • ENT (Ear, Nose, and Throat)

    See Otolaryngology.

  • Family Practice (FP)

    Medical Doctors who diagnose and treat medical conditions for people of all ages with an emphasis on family health problems.

  • Gastroenterology

    Diagnosis and treatment of diseases and disorders of the stomach, intestines, liver and gallbladder.

  • General Practice (GP)

    Medical Doctors who diagnose and treat diseases, injuries and disorders for people of all ages.

  • Geriatric Medicine

    Diagnosis and treatment of medical conditions in the elderly.

  • Geriatric Physician (Ger)

    Medical Doctor providing comprehensive diagnosis, evaluation and care for elderly individuals.

     
  • Gynecologic Oncology

    Diagnosis and treatment of cancers of the female reproductive organs, such as ovarian cancer, cervical cancer and uterine cancer.

  • Hematology

    The treatment of diseases of the blood, spleen and lymph glands.

  • Infectious Disease

    Diagnosis and treatment of complicated infections, including those associated with patients with reduced ability of the immune system such as leukemia patients, organ transplant recipients and HIV-related diseases.

  • Internal Medicine (IM)

    Medical Doctors who diagnose and treat diseases and disorders of the body for people over age 18; includes basic and preventive treatment and diagnosis and treatment of acute and chronic illnesses.

  • MD (Medical Doctor)

    Physician who has had four years of premedical education in a college or university followed by four years of medical school.

  • Maternal and Fetal Medicine

    Treatment for patients with complicated pregnancy.

  • Medical Oncology

    Diagnosis and treatment of the abnormal growth of tissue (cancer).

  • Neonatal-Perinatal Medicine

    Care for high-risk infants, including pre-term and full-term infants with medical or surgical problems.

  • Nephrology

    Diagnosis and treatment of diseases and disorders of the kidneys.

Medical Terms 2