Health insurance terms can be confusing from time to time. Refer to our glossary to see the explanation for every term listed and to find reference material which deepen your understanding of the subject.

A

  • 24 Hour Approval:
  • How It Works:
  • Access:
  • Accident:
  • Accumulation Period:
  • Actively-at-work:
  • Actual Charge:
  • Actuary:
  • Acupuncture:
  • Acute Care:
  • Additional Drug Benefit List:
  • Administrative Services Only (ASO) Agreement:
  • Admissions/1,000:
  • Admits:
  • Adverse Selection:
  • Age Change:
  • Age Limits:
  • Age/Sex Factor:
  • Agent:
  • Allied Health Personnel:
  • Allowable Charge:
  • Allowable Costs:
  • Allowed Amount:
  • Alternate Delivery System:
  • Alternative Medicine:
  • Ambulatory Care:
  • Ambulatory Setting:
  • Ancillary Fee:
  • Ancillary Products:
  • Ancillary Services:
  • Annual limit:
  • Application Fee:
  • Approved Charge:
  • Approved Health Care Facility or Program:
  • Assignment of Benefits:
  • Attending Physician Statement (APS):

B

  • Balance Billing:
  • Basic Hospital Expense Insurance:
  • Bed Days/1,000:
  • Benefit:
  • Benefit Level:
  • Benefit Package:
  • Benefit Riders:
  • Benefit Year:
  • Binding Receipt:
  • Birthday Rule:
  • Board-certified:
  • Broker:
  • Business License:
  • Business Structure:

C

  • COB (Coordination of Benefits):
  • COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985):
  • Capitation:
  • Carrier:
  • Carry-over Provision:
  • Case Management:
  • Centers for Medicare and Medicaid Services:
  • Certificate of Coverage:
  • Chemical Dependency Inpatient:
  • Chiropractic:
  • Chronic:
  • Claim:
  • Coinsurance:
  • Company:
  • Cost-sharing:
  • Co-payment:

D

  • Date of Service:
  • Deductible:
  • Deductible Carry-over Credit:
  • Department of Health and Human Services:
  • Dependent Coverage:
  • Designated Mental Health Provider:
  • Drug Formulary:
  • Drug Maintenance List:
  • Drug Utilization Review (DUR):
  • Durable Medical Equipment (DME):

E

  • ERISA (Employment Retiree Income Security Act of 1974):
  • Effective Date:
  • Eligibility Date:
  • Eligibility Requirements:
  • Eligible Dependent:
  • Eligible Employee:
  • Eligible Expenses:
  • Eligible Person:
  • Emergency Room:
  • Employee Certificate of Insurance:
  • Employee Contribution:
  • Employer Contribution:
  • Employer Wage and Tax Statement:
  • Enrollee:
  • Enrollment:
  • Enrollment Period:
  • EPO(Exclusive Provider Organization):
  • Essential Benefits:
  • Estimated Cost:
  • Evidence of Coverage:
  • Evidence of Insurability:
  • Examination:
  • Exclusions:
  • Experimental or Investigational Procedures:
  • Explanation of Benefits (EOB):
  • Extended Coverage:
  • Extension of Benefits:

F

  • Fee-For-Service Plan:
  • Fictitious Business Name Statement:
  • Formulary:

G

  • Gatekeeper:
  • Generic Drug:
  • Grace Period:
  • Grandfathered plan:
  • Grievance Procedure:
  • Group:
  • Group Health Insurance:
  • Guaranteed Issue:
  • Guaranteed Renewable Contract:

H

  • HIPAA (Health Insurance Portability and Accountability Act of 1996):
  • HMO:
  • HSA (Health Savings Account):
  • Health Care Financing Administration (HCFA):
  • Health Service Agreement:
  • High Deductible Health Plan (HDHP):
  • Home Health Agency:
  • Home Health Care:
  • Hospice Care:
  • Hospital Benefits:
  • Hospitalization:
  • Hospitalization Insurance:

I

  • IPA (Individual Practice Association):
  • In-area Services:
  • Incontestable Clause:
  • Indemnity Plan:
  • An Indemnity plan may be right for you if:
  • Individual and Family Health Insurance:
  • Infertility:
  • Inpatient:
  • Integrated Delivery System:
  • Intermediate Care:

J

K

L

  • Lab/X-Ray:
  • Lapse:
  • Length of Stay (LOS):
  • Lifetime Limit:
  • Lifetime Maximum:
  • Limitations:
  • Long-term Care:

M

  • MSA (Medical Savings Account):
  • Major Medical Insurance:
  • Managed Care:
  • Maternity (Inpatient):
  • Maternity (Outpatient):
  • Maternity Coverage:
  • Maximum Allowable:
  • Max Duration:
  • Maximum Out-Of-Pocket Costs:
  • Medicaid:
  • Medical Necessity:
  • Medicare:
  • Medicare Beneficiary:
  • Medicare Supplement Insurance:
  • Member:
  • Mental Health Inpatient:
  • Mental Health Office Visits:

N

  • National Association of Insurance Commissioners (NAIC):
  • National Drug Code (NDC):
  • Network:
  • A Network plan may be right for you if:
  • Network Provider:
  • Non-duplication of Benefits:
  • Nursing Home:

O

  • Office Visit:
  • Office Visit (IFP):
  • Open Enrollment Period:
  • Out-of-network Care:
  • Out-of-pocket Costs:
  • Out-of-Pocket Maximum:
  • Outpatient:
  • Outpatient Surgery:
  • Over-the-counter (OTC) Drugs:

P

  • POS:
  • A POS plan may be right for you if:
  • PPO:
  • A PPO may be right for you if:
  • Part-Time Employee:
  • Partial Disability:
  • Partial Hospitalization Services:
  • Participating Provider:
  • Peer Review:
  • Periodic Health Exam:
  • Periodic OB-GYN Exam:
  • Physical Therapy:
  • Place of Service:
  • Plan Name:
  • Plan Type:
    • PPO
    • HMO
    • Network
    • POS
    • Indemnity
  • EPO (Exclusive Provider Organization).
  • Policy Form Number:
  • Policy Term:
  • PPACA:
  • Practical Nurse:
  • Pre-Admission Authorization:
  • Preauthorization/Precertification:
  • Pre-existing Condition:
  • Pre-existing Condition Exclusion:
  • Premium:
  • Prescription Medication:
  • Prescription Drug Coverage:
  • Preventive benefits:
  • Preventive Care:
  • Primary Care:
  • Primary Care Physician (PCP):
  • Primary Coverage:
  • Prior Authorization:
  • Probationary Period:
  • Provider:
  • Provider Write-off:

Q

  • Qualifying Event:

R

  • Rating Process:
  • Reasonable and Customary Charges:
  • Referral:
  • Registered Nurse (RN):
  • Renewal:
  • Renewal Date:
  • Respite Care:
  • Rider:

S

  • Schedule C:
  • Schedule K-1:
  • Second Surgical Opinion:
  • Secondary Care:
  • Secondary Coverage:
  • Self-funded Health Insurance Plan:
  • Service Area:
  • Short-term Plans:
  • Skilled Nursing Care:
  • Small group market:
  • Specialist:
  • Standard Industrial Classification (SIC) Codes:
  • Subrogation:
  • Subscriber:

T

  • Temporary Partial Disability:
  • Temporary Total Disability:
  • Tertiary Care:
  • Terminally Ill:
  • Treatment Facility:
  • Triage:

U

  • Underwriting:
  • Uniform Billing Code of 1992 (UB-92):
  • Usual, Customary and Reasonable (UCR) Charge:
  • Utilization:
  • Utilization Management/Review:

V

  • Vision Care Coverage

X

Y

Z