Health Insurance Glossary – F Terms
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
F
Fee-for-Service (FFS) Plan
A health insurance plan that reimburses policyholders for covered health care costs, irrespective of what health care provider is used. The insurer is normally required to pay a fixed percentage (say 80%) of the usual, customary and reasonable health care costs for the service after a deductible has been met, leaving the individual to pay 20% plus any amount considered in excess of the usual, customary and reasonable rate.
Fee-for-Service plans were very common prior to the advent of HMOs, IPAs and PPOs, and provide individuals with considerable freedom to choose their own health care providers. Because Fee-for-Service plans to not restrict or encourage individuals to use an In-Network Provider, the premiums are likely to be higher than for other health plans.
A Fee-for-Service plan may also require an individual to pay the full amount for services up-front and then submit a claim to the insurance company for reimbursement. As a result this type of plan often requires and individual to complete more paperwork.
Also known as an Indemnity Plan.
Formulary
See Drug Formulary.
Fraud
Intentional deceit, misrepresentation or concealment for financial gain or to obtain some other advantage.
