Glossary Of Terms

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Actuary

Administrative Services Only (ASO)

Adverse Selection

Attachment Point

Balance Billing

Beneficiary

Benefit Period

Cafeteria Plan

Capitation

Claim

Closed Panel

Co-insurance

Community Rating

Conversion Privilege

Coordination of Benefits (COB)

Co-payment

Cost Containment

Cost Shifting

Coverage

Coverage Expense(s)

Deductible

DOL

Dual Choice

Eligible Expense(s)

ERISA (Employee Retirement Income Security Act of 1974)

Evidence of Insurability

Exclusion

Exclusive Provider Organization (EPO)

Expected Claims

Experience

Experience rating

Experience refund

Explanation of Benefits (EOB)

Extended Benefits

Federally Qualified HMO

Fee for Service Reimbursement

Fiduciary

Fixed Costs

Flexible Spending Account (FSA)

Fully Insured Plans

Gatekeeper (Primary Care Physician)

Gatekeeper Question

Grace Period

Guaranteed Issue Underwriting

Guaranteed Renewable

Health Alliances

Health Insurance Portability and Accountability Act (HIPAA)

Health Insurance Purchasing Cooperatives (HIPCS)

Health Maintenance Organization (HMO)

Health plan administrator (HPA)

Health Reimbursement Arrangement (HRA)

Health Savings Account (HSA)

High Risk Pool

Incontestability

Incurred But Not Reported (IBNR)

Indemnity Plan

Individual Practice Association (IPA)

Insurability

Insured

Insurer

Internal Revenue Service(IRS)

Key Person Insurance

Lagged Claims

Lapse

Lifetime Aggregate or Maximum

Long Term Care (LTC)

Major Medical Insurance

Managed Care

Managed Care Program

Managed Competition

Mandate

Medicaid

Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA)

Medicare Supplement

Mental Health Parity Act (MHPA)

Modified Adjusted Gross Income (MAGI)

Multi-employer Plan

Multiple Employer Welfare Arrangement (MEWA)

National Association of Insurance Commissioners (NAIC)

National Defense Authorization Act of 2008 (NDAA)

Network

Omnibus Budget Reconciliation Act of 1989 (OBRA '89)

Open Panel

Out-of Pocket Maximum

Over-the-counter (OTC)

Participating Provider

Pension Benefit Guaranty Corporation (PBGC)

Plan Year

Point of Service Plan (POS)

Policy

Pool(ing)

Portability

Pre-existing Condition

Pre-existing Condition Clause

Pre-existing Condition Exclusion Period

Preferred Provider Organization (PPO)

Premium Only Plan (POP)

Prepaid Group Practice

Primary Care

Professional in Human Resources (PHR)

Protected Health Information (PHI)

Provider

Qualified Beneficiary (QB)

Reasonable and Customary

Rebating

Reinsurance

Reserves

Retention

Rider (Exclusion)

Seasonal Employees

Self-funding

Senior Professional in Human Resources (SPHR)

Service Area

Small Business Job Protection Act of 1996 (SBJPA)

Staff Model HMO

Summary Plan Description (SPD)

Technical And Miscellaneous Revenue Act of 1988 (TAMRA)

Third-party Administrator (TPA)

Tort Reform

Trade Adjustment Assistance (TAA)

Trend Factor

Triple Option Plan

Unbundling

Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA)

Utilization

Utilization Review

Waiting Period

Waiver of Premium

Wellness

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