Glossary

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Open Enrollment

A specified period of time during which individuals may enroll or change their benefits program.

Open-Ended HMOs

HMOs that allow individuals enrolled in the plan to to use out-of-plan providers and still receive partial or full coverage and payment for the professional's services under a traditional indemnity plan.

Out-of-Plan (or Out-of-Network)

A term commonly used in health insurance policies to refer to This phrase refers to doctors, hospitals or other health care providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO). Out-of-Plan expenses may not be covered at all, or, in some cases may be reimbursed or partially reimbursed by the insurance company.

Out-of-Pocket

The amount of money that a policyholder must pay out of their own funds before an insurance company or (self-insured employer) will pay 100 percent for an individual's health care expenses. This amount is predetermined and set in the terms of the policy's coverage.

Outpatient

A patient that receives treatment or care, including some surgies, but that is released the same day and does not stay overnight in a hospital.
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