HEALTH INSURANCE: GLOSSARY OF TERMS Part3 P-W

Paid Claims

Amounts paid to providers based on the health plan. 

Paid Claims Loss Ratio 

Paid claims divided by total premiums. 

Participating Provider 

(1) A health care provider under contract with a health insurer or managed care organization. (2) A health care provider approved by Medicare to participate in the program and receive benefit payments directly from carriers or fiscal intermediaries. 

Read More

HEALTH INSURANCE: GLOSSARY OF TERMS Part2 E-O

Eligible Expenses
Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or customary and reasonable or allowable charges.

 Eligibility Date
The date that a person is eligible for benefits.

Eligibility Period
(1) The period of time during which potential members of a Group Life or Health program may enroll without providing evidence of insurability. Sometimes called “Open Enrollment.” (2) The period of time under a Major Medical policy during which reimbursable expenses may be accrued.

Read More

Health insurance: GLOSSARY OF TERMS Part1 A-D

Accidental Death and Dismemberment

A policy or a provision in a policy which pays benefits if the insured dies, loses his or her sight, or loses two limbs as the result of an accident. A lesser amount, usually half, is payable for the loss of one eye, arm, leg, hand, or foot. Generally companion coverage to group term life insurance, LHSIC offers this as a benefit in its individual health insurance policies.

Accreditation

A designation indicating that an insurer’s networks or a managed care organization has been evaluated and has met the standards of a certifying body, such as the National Committee for Quality Assurance (NCQA) or the Utilization Review Accreditation Commission (URAC). The designation can help purchasers, regulators, and consumers assess managed care plans.

Accrual

An accounting term to describe the practice of recognizing an expense or revenue that has been realized but has not yet been recorded.

Read More