Glossary

 
O
Obamacare
A nickname for the Patient Protection and Affordable Care Act.
Occupational Therapy

Treatment to restore a physically disabled person's ability to perform activities such as walking, eating, drinking, dressing, toileting, and bathing (activities of daily living).

Omnibus Budget Reconciliation Act OBRA

A federal act which sets guidelines for Medicare and insurers.

Open Enrollment

A limited time period in which enrollment applications for coverage elections or changes may be made. Certain changes such as adding a spouse upon marriage or adding a newborn child may be made at any time during the year.

Ordering Provider

The physician or other provider who specifically prescribes the health care service being reviewed.

Out of Network Benefits

Reimbursement for covered services provided by out-of-network providers and suppliers. Out-of-network benefits are generally subject to a deductible and coinsurance and, therefore, have higher out-of-pocket costs. Depending on your contract, out-of-network services may not be covered. Please refer to your contract for specific benefit coverage.

Out-of-Network

The use of health care providers who have not contracted with the health plan to provide services. Depending on your contract, out-of-network services may not be covered. Please refer to your contract for specific benefit coverage.

Out-of-Pocket Costs

Expenses that plan members must pay with their own money as part of their health coverage. Such costs as a rule include deductibles, copayments and coinsurance.

Out-of-Pocket Maximum

The maximum dollar amount per calendar year you will have to pay for covered services.

Outpatient Care

Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility

Outpatient Surgery

Surgical procedures performed that do not require an overnight stay in the hospital or ambulatory surgery facility. Such surgery can be performed in the hospital, a surgery center, or physician office.