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Glossary Terms

A – C

Access
Accident
Accumulation Period
Actual Charge
Actuary
Acute Care
Age Change
Age Limits
Age/Gender Factor
Allowable Charge
Alternative Delivery System
Alternative Medicine
Ambulatory Care
Ancillary Products
Ancillary Services
Application Fee
Approved Health Care Facility (or Program)
Assignment of Benefits
Attending Physician Statement (APS)
Balance Billing
Benefit
Benefit Level		 Benefit Package
Benefit Year
Board Certified
Calendar-Year Deductible
Capitation
Carrier
Carry-Over Provision
Case Management
Certificate of Coverage
Chronic
Claim
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)
Coinsurance
Coinsurance Out-of-pocket Maximum
Complications of Pregnancy
Coordination of Benefits (COB)
Copayment
Covered Amount
Covered Expense
Critical Illness Insurance

D – G

Date of Service
Deductible
Deductible Carryover
Dental Insurance
Dependent
Diagnosis
Drug Formulary
Drug Maintenance List
Drug Utilization Review
Durable Medical Equipment (DME)
Effective Date
Electronic Funds Transfer
Eligibility Date
Eligibility Requirements
Eligible Dependent
Eligible Expenses		 Emergency
Evidence of Insurability
Examination
Exclusions
Experimental or Investigational Procedures
Explanation of Benefits
Explanation of Denial
Extended Coverage
Extension of Benefits
Family Deductible
Fee for Service
Formulary
Generic Drug
Grace Period
Grievance Procedure
Guarantee(d) Issue
Guaranteed Renewable

H – M

Health Maintenance Organization
Health Savings Account (HSA)
HIPAA (Health Insurance Portability and Accountability Act of 1996)
Home Health Agency
Hospice Care
Hospital Benefits
Hospitalization
Hospitalization Service
In-Area Services
In-Network Care
Indemnity Plan
Individual and Family Health Insurance
Infertility
Inpatient
Intermediate Care
Lab/X-ray		 Lapse
Length of Stay (LOS)
Lifetime Maximum
Limitations
Long-Term Care
Major-Medical Insurance
Managed Care
Maximum Allowable
Maximum Duration
Maximum Out-of-Pocket Costs
Medicaid
Medical Expense Benefit
Medical Information Bureau (MIB)
Medical Necessity
Medicare
Member

N – Q

National Association of Insurance Commissioners (NAIC)
National Drug Code (NDC)
Network
Network Provider
Notice of Information Practices
Nursing Home
Office Visit
Optional Benefit
Out-of-Network Care
Out-of-Pocket Costs
Out-of-Pocket Maximum
Outpatient
Outpatient Surgery
Over-the-Counter (OTC) Drugs
Participating Provider
Peer Review
Periodic Health Exam		 Periodic OBGYN Exam
Physical Therapy
Place of Service
Plan Name
Plan Type
Point of Service (POS) Plan
Policy Form Number
Policy Term
Preauthorization or Precertification
Preexisting Condition
Preexisting Condition Exclusion
Preferred Provider Organization (PPO)
Premium
Prescription Drug Coverage
Prescription Medication
Preventive Care
Primary Coverage
Qualifying Event

R – Z

Referral
Renewable Health Plan
Renewal
Renewal Date
Repriced Amount
Rider
Second Surgical Opinion
Secondary Care
Secondary Coverage
Service Area
Short Term Plan
Skilled Nursing Care
Specialist		 State Variation
Subrogation
Supplemental Accident
Temporary Partial Disability
Temporary Total Disability
Underwriting
Uniform Billing Code of 1992 (UB-92)
Utilization
Vision Care Coverage
Waiting Period
Waiver of Premium
Well-Baby/Well-Child Care
Well-Woman Care
Note: These definitions are provided only to give you a general understanding of how these words are sometimes used by health insurance companies. Please refer to your coverage documents for a complete list of defined terms that apply to your specific coverage.
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