Glossary - Know exactly like a health insurance expert !
What is A&H, A&S. Accident and Health Insurance, Accident and Sickness Insurance?
Once commonly used as generic designations for the entire field now called Health Insurance. See Health Insurance.
What is Accelerated Benefits?
Riders on life insurance policies which allow the life insurance policy's death benefits to be used to offset expenses incurred in a convalescent or nursing home facility. (H, LI)
What is Access?
A person's ability to obtain affordable medical care on a timely basis.
What is Accident and Health Insurance (A&H)?
An older name for Health Insurance. See Health Insurance.
What is Accident and Sickness Insurance (A&S)?
An older name for Health Insurance. See Health Insurance.
What is Accident Insurance?
A form of insurance against loss by accidental bodily injury to the insured.
What is Accidental Death and Dismemberment?
Can either be sold as a policy by itself or can be included as a provision of a policy. In the case of an accident, the insurance company will pay either a lump sum or a weekly amount over a specific period.
What is Accidental Death Benefit?
An extra benefit which generally equals the face of the contract or principal sum, payable in addition to other benefits in the event of death as the result of an accident. See also Double Indemnity and Multiple Indemnity. (LI,H)
What is Accidental Death Insurance?
A form that provides payment if the death of the insured results from an accident. It is often combined with Dismemberment Insurance in a form called Accidental Death and Dismemberment. See also Accidental Death and Dismemberment. (LI,H)
What is Accreditation Status?
Based on a variety of quality standards the National Committee for Quality Assurance grants health plans three classes of accreditation: Full, One-Year, and Provisional.
What is Actively-at-work?
Most group health insurance policies state that if an employee is not actively at work on the day the policy goes into effect, the coverage will not begin until the employee does return to work.
What is Activities of Daily Living (ADL)?
Everyday living functions and activities performed by individuals without assistance. These functions would include mobility, dressing, personal hygiene and eating.
What is Activities of Daily Living (ADL) Standards?
Used to assess the ability of an individual to live independently, measured by the ability to perform unaided such activities as eating, bathing, toiletry, dressing, and walking. ADL standards are sometimes discussed as a way to measure or define eligibility for long term care.
What is Actual Charge?
The actual amount charged by a physician for medical services rendered.
What is Acute Care?
Skilled, medically professional care given to a patient in order to restore them to functional health.
What is Additional Drug Benefit List?
Prescription drugs listed as commonly prescribed by physicians for patients' long-term use. Subject to review and change by the health plan involved. Also called drug maintenance list.
What is Additional Insured?
An individual covered under the plan that is not named as an insured in the policy's terms
What is Additional Monthly Benefit?
Riders added to disability income policies to provide additional benefits during the first year of a claim while the insured is waiting for Social Security benefits to begin.
What is Adjusted Average Per Capita Cost (AAPCC)?
The estimated average cost of Medicare benefits established on a per county basis _ factors include age, sex, Medicaid, institutional status, disability, and end stage renal disease status. Used to determine payments to cost contractors for Medicare benefits.
What is Adjusted Community Rating (ACR)?
Community rating adjusted by factors specific to a particular group. Also known as factored rating.
What is Admissions/1,000?
The number of hospital admissions for each 1,000 members of the health plan.
What is Admitting Privileges ?
The right granted to a doctor to admit patients to a particular hospital.
What is Adult Day Care?
A group program for functionally impaired adults, designed to meet health, social and functional needs in a setting away from the adult's home.
What is Advocacy?
Any activity done to help a person or group to get something the erson or group needs or wants.
What is Aftercare?
Individualized patient services required after hospitalization or rehabilitation.
What is Age Change?
The date on which a person's age, for insurance purposes, changes. In most Life Insurance contracts this is the date midway between the insured's natural birth dates. Health insurers frequently use the age of the previous birth date for rate determinations. On the date of age change, a person's age may change to that of the last birth date, the nearer birth date, or the next birth date, depending upon the way in which the rating structure has been established by that particular insurer. (LI,H)
What is Age/Sex Factor?
Compares the age and sex risk of medical costs of one group relative to another. An age/sex factor above 1.00 indicates higher than average risk of medical costs due to that factor. Conversely, a factor below 1.00 indicates a lower than average risk. This measurement is used in underwriting.
What is Age/Sex Rates (ASR)?
Separate rates are established for each grouping of age and sex categories. Preferred over single and family rating because the rates and premiums automatically reflect changes in the age and sex content of the group. Also sometimes called table rates.
What is Aggregate Indemnity?
A maximum dollar amount that may be collected by the claimant for any disability, for any period of disability, or under the policy as a whole.
What is Allied Health Personnel?
Health personnel who perform duties which would otherwise have to be performed by physicians, optometrists, dentists, podiatrists, nurses, and chiropractors. Also called paramedical personnel.
What is Allocated Benefits?
Payments authorized for specific purposes with a maximum specified for each. In hospital policies, for instance, there may be scheduled benefits for X-rays, drugs, dressings, and other specified expenses.
What is Allowable Charge?
The lesser of the actual charge, the customary charge and the prevailing charge. It is the amount on which Medicare will base its Part B payment.
What is Allowable Costs?
Charges which qualify as covered expenses.
What is Alternative Delivery Systems?
Systems which cover health care costs, other than on the usual fee-for-service basis. Could include HMOs, IPAs, PPOs, etc.
What is Alzheimer's Disease?
A progressive, irreversible disease characterized by degeneration of the brain cells and severe loss of memory causing the individual to become dysfunctional and dependent upon others for basic living needs.
What is Ambulatory Care?
Similar to outpatient treatment in that it is care which does not require hospitalization.
What is Ambulatory Setting?
Institutions such as surgery centers, clinics, or other outpatient facilities which provide health care on an outpatient basis.
What is Ancillary?
Additional services (other than room and board charges) such as X-rays, anesthesia, lab work, etc. Fees charged for ancillary care such as X-rays, anesthesia, and lab work. This term may also be used to describe the charge made by a pharmacy for prescriptions which exceed the health insurance plan's maximum allowable cost (MAC).
What is Ancillary Benefits?
Benefits for miscellaneous hospital charges.
What is Approved Charge?
Amounts paid under Medicare as the maximum fee for a covered service.
What is Approved Health Care Facility or Program?
A facility or program which has been approved by a health care plan as described in the contract.
What is Assignment?
An authorization to pay Medicare benefits directly to the provider. Medicare payments may be assigned to participating providers only.
What is Assignment of Benefits?
A method where the person receiving the medical benefits assigns the payment of those benefits to a physician or hospital.
What is Assisted Living Facility?:
A residential community for senior citizens that also provides nursing care.
Association: A group. Often, associations can offer individual health insurance plans specially designed for their members.
What is Average Cost Per Claim?
The total cost of administrative and/or medical services divided by the number of units of exposure such as costs divided by number of admissions, or cost divided by number of outpatient claims, etc.
What is Average Length of Stay (ALOS)?
The total number of patient days divided by the number of admissions and discharges during a specified period of time. This gives the average number of days in the hospital for each person admitted.
What is Average Wholesale Price (AWP)?
Under the Medicare catastrophic coverage act, payment for prescription drugs is limited to the lowest of the pharmacy's actual charge, the sum of the AWP for the drug plus an administrative allowance, or effective 1992, the 90th percentile of pharmacy charges.
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