Diagnosis and treatment of mental health and substance abuse disorders.
The dollar amount Quartz contributes toward the payment of covered health care services.
A prescription drug that is protected by a patent, supplied by a single company, and marketed under the manufacturer's brand name.
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.
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.
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.
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.
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.
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.
A person who receives health insurance through a spouse, parent or other family member.
A Fee Schedule lists the maximum amount of money Quartz will reimburse a hospital or health care provider for covered services.
A list of prescription drugs covered by Quartz health plans. Your plan documents state the formulary that applies to your plan.
A chemically-equivalent copy designed from a brand-name drug whose patent has expired (typically less expensive and sold under the common name).
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.
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).
A person enrolled in a Quartz health plan.
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.
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.
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.
A person who participates in the health benefit plan offered by their employer / plan sponsor.
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.
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.
A person who supplies health care services, i.e., physician, psychologist, nurse practitioner.
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.
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.
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.
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.
The person in whose name a health insurance certificate or insurance policy is held.
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.
Diagnosis and treatment of allergic conditions and diseases of the immune system.
Administration of anesthesia to achieve temporary, partial or complete loss of sensation to patient undergoing surgery.
Diagnosis and treatment of hearing, speech and language disorders
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.
A person who assists women in childbirth.
Nurses who are specially trained to assume an expanded role in providing medical care under the supervision of a physician.
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.
See Oncology, Medical Oncology, Gynecologic Oncology and Radiation Oncology.
Diagnosis and treatment of diseases of the heart and blood vessels.
Treatment that utilizes the relationship between the musculoskeletal structures and functions of the body, particularly of the spinal column and the nervous system.
Health care provided to a critically ill patient during a medical emergency or crisis.
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.
Care and treatment of the teeth and gums.
Diagnosis and treatment of diseases and disorders of the skin.
Diagnosis and treatment of diseases and disorders of the endocrine glands (thyroid, pituitary, pancreas, ovaries and testes), including diabetes.
Medical Doctors who diagnose and treat medical conditions for people of all ages with an emphasis on family health problems.
Diagnosis and treatment of diseases and disorders of the stomach, intestines, liver and gallbladder.
Medical Doctors who diagnose and treat diseases, injuries and disorders for people of all ages.
Diagnosis and treatment of medical conditions in the elderly.
Medical Doctor providing comprehensive diagnosis, evaluation and care for elderly individuals.
Diagnosis and treatment of cancers of the female reproductive organs, such as ovarian cancer, cervical cancer and uterine cancer.
The treatment of diseases of the blood, spleen and lymph glands.
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.
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.
Physician who has had four years of premedical education in a college or university followed by four years of medical school.
Treatment for patients with complicated pregnancy.
Diagnosis and treatment of the abnormal growth of tissue (cancer).
Care for high-risk infants, including pre-term and full-term infants with medical or surgical problems.
Diagnosis and treatment of diseases and disorders of the kidneys.