tag:blogger.com,1999:blog-8289776956644930932024-03-08T12:42:34.746-08:00insurance worldnewcamdservershttp://www.blogger.com/profile/11054975238236313257noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-828977695664493093.post-10222056317053020702012-12-12T11:04:00.002-08:002012-12-12T11:16:35.063-08:00The Cooperative Insurance in Saudi Arabia: A Nucleus to health Reform Policy<div dir="rtl" style="text-align: right;" trbidi="on">
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<b><span style="color: red;">2011 International Conference on Information and Finance IPEDR vol.21 (2011) © (2011) IACSIT Press, Singapore</span></b></div>
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<b><span style="color: red;">Created by:</span></b><br />
Deena M Barakah, DDS : Dental Clinic Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia<br />
E-mail address: <a href="mailto:drdeena@gmail.com">drdeena@gmail.com</a><br />
Shakir Ahmed Alsaleh : School of Public Health & Health Informatics, King Saud bin Abdulaziz University for Health Sciences<br />
E-mail address: <a href="mailto:Alsalehs@ksau-hs.edu.sa">Alsalehs@ksau-hs.edu.sa</a><br />
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<b><span style="color: red;">Abstract.</span></b> In order to fulfill the country's health sector developmental objectives, the Kingdom of Saudi</div>
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Arabia has endeavored to reorganize and improve its health care systems. One area of health sector that has</div>
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undergone profound change and significant progress is health insurance. A comprehensive health insurance</div>
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programs - based on the Islamic concepts- have been created and implemented through a new government</div>
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council for cooperative insurance. This paper discusses the Saudi health insurance act, its Islamic philosophy,</div>
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implementations of its programs and a brief summary of its concrete accomplishments. A detailed discussion</div>
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is given for the many challenges and difficulties faced the implementation of this act. The Saudi cooperative</div>
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health insurance innovative approach to health care development, can serve as a model program for</div>
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developing countries undergoing rapid health sector development. Evaluation of its effectiveness in</div>
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providing improved health care in the kingdom of Saudi Arabia may also offer an example for other Arab</div>
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and Islamic countries with similar health care needs.</div>
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<b><span style="color: red;">Keywords:</span></b> Islamic Cooperative Insurance (Takaful), Saudi health systems, Health Insurance in</div>
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developing countries</div>
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<b><span style="color: red;">1. Introduction:</span></b></h3>
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The overall development boom witnessed by the Kingdom of Saudi Arabia over the past four decades</div>
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has led to a steady growth of the population of the Kingdom of Saudi Arabia (3.1% per annum), one of the</div>
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highest in the world. In addition, the country infrastructure development required a large number of foreign</div>
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expatriate workers. This brought to the country more than seven million workers. In view of the existence of</div>
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this population growth coupled with the huge workforce expansion, the demand on health services soared</div>
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and associated with a considerable rise in the cost of health care. This has reflected on the significant of the</div>
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health services and encumbered public hospitals from providing satisfactory health care.</div>
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Health insurance system has been anticipated as a strategic solution to this problem and hopefully</div>
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expected to realize many objectives of health care sector development. [1] The start of the health insurance</div>
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reform was initiated on 1999, when the council of Ministers passed a resolution for the establishment of</div>
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cooperative health insurance system aiming at the provision of health care and its organization to cover all</div>
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the non – Saudi residents working in the private sector and their families. Later on, the Cooperative Health</div>
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Insurance act was issued by a Royal Decree no: M /10 on August 1999.</div>
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<b><span style="color: red;">1.1. Methodology of the Paper:</span></b></h3>
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In this paper, we present a summary of the progress made to implement health insurance system in the</div>
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kingdom. A detailed discussion is given for the many challenges and difficulties faced the implementation of</div>
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this act. An exploratory approach is used as a primary research method to determine the status of the</div>
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cooperative health insurance system in the kingdom of Saudi Arabia. Our study is mainly based on the rich</div>
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literature of Muslim scholars on Cooperative insurances, the Saudi insurance act contents, and on official</div>
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cooperative health insurance council reports, statistics and documents.</div>
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<span style="color: red;">1.2. Related Works and Research Significances:</span></h3>
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Prior work on this subject has focused on assessing the application of Islamic principles into insurance</div>
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and how this type of insurance arrangement works.[2-4] Several research studies also investigated the growth</div>
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of “Takaful” insurance industry and its availability and operation on various countries, especially those with</div>
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a significant Muslim population. [5-7]. Studies on the level of knowledge and understanding among Muslims</div>
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towards the Takaful concepts are presented in reference [8, 9]. The development of Saudi health sector</div>
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based on Takaful insurance is presented in several official reports[1, 10-13] While these published works</div>
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are valuable, it is also fundamentally important for researchers to continuously monitor and document the</div>
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health care progress and improvement surrounding using new insurance approaches. With lack of sufficient</div>
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research studies on Saudi health community, this work seeks to address this gap via presenting a descriptive</div>
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study of the current status of cooperative insurance in the kingdom health sector. As few studies have</div>
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discussed health insurance in Saudi Arabia, the work presented in this paper, may therefore be the base for</div>
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other studies to come. The description of applications and progress of cooperative insurance in Saudi health</div>
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sectors is also a valuable initial step towards evaluation of their effectiveness in providing improved health</div>
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care in the kingdom of Saudi Arabia.</div>
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<b><span style="color: red;">1.3. Paper Organization:</span></b></h3>
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The paper is organized as follows: The subject of building the insurance industry on the Islamic principle</div>
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and Shariah (Islamic law) is discussed in the next section. This section reviews the concepts and principles of</div>
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Islamic cooperative insurance which is proposed as an alternative to conventional insurance. In section three,</div>
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the trends and history of Cooperative health insurance is covered. Section four describes the Cooperative</div>
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Health Insurance Act and the role of the council of cooperative health insurance that has been formed to</div>
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implement the act in the Saudi society. In section five, we review the challenges, progress, and achievements</div>
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made so far in applying the Takaful system in the kingdom. Complications that faced the growth of the</div>
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health insurance industry are discussed in section six. Finally, the conclusion sections summarize the result</div>
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of this study.</div>
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<b><span style="color: red;">2. Islamic Cooperative Insurance (Takaful):</span></b></h3>
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Muslim jurists generally agree that Islamic insurance Takaful is based on principles of mutuality and</div>
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cooperation. These necessities shared responsibility, joint indemnity, common interest and solidarity, and</div>
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freedom from Islamic forbidden elements such as gambling, uncertainty and interest. As an insurance</div>
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business, Takaful is perceived as a cooperative insurance, where members contribute a certain sum of</div>
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premiums money to a common fund with not profits purpose but to uphold the principle of “bear ye one</div>
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another’s burden." Based on this, the main principles of Takaful insurance are as follows: [6, 14]</div>
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• Every policyholder pays his premiums to a common Takaful fund</div>
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• Losses are shared and liabilities spread among participants as any participant suffering illness would</div>
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receive a certain sum of money or financial benefit from Takaful fund as defined in the insurance pact.</div>
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• All transactions and commercial activity of Takaful must be in accordance with the Islamic principles</div>
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and in compliance with the Shariah (Islamic Laws).</div>
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• Uncertainty is minimized in respect of subscription and compensation by implementing the concept of</div>
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Tabarru (denotation). Thus each participant shall agree to give certain portion of his Takaful instalments</div>
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as “a donation”.</div>
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• An insurance company is established as manager of the Takaful Operations and is allowed to charge a</div>
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management fee for Takaful transactions.</div>
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• The Takaful Fund, consisting of the premiums paid as donations, is further invested by the Company in</div>
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compliance with the Shariah law with no element of interest (Riba) involved. The investment profit will</div>
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be shared on agreed ratio. This surplus is normally distributed on expiry of each insured’s insurance</div>
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policy.</div>
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• If the participants premiums and investment are insufficient to meet these adjustments, those affected</div>
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insured could be assessed for additional contributions.</div>
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The above key issues reflect the basic differences between Takaful and conventional insurance. [15]</div>
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<b><span style="color: red;">3. Trends and History of Takaful Health Insurance:</span></b></h3>
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Takaful, or Islamic insurance concepts are based on the principles of TA-AWUN (mutual assistance and</div>
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cooperation) and Tabarru (Voluntarily) origin. These can be traced back to Islamic guidance revealed in the</div>
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holy Quran fourteen centuries ago. The development of Islamic insurance (Takaful) in recent times was first</div>
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initiated in Sudan in 1979 and Malaysia in 1984[16]. The practice was given a strong support by the 1985</div>
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Fiqh (Jurisprudence) Complex ruling declaring that conventional commercial insurance is not allowed</div>
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islamiclly and that the application of insurance business should be based on the cooperative principles.</div>
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Since then, the Takaful industry operations, expanded very rapidly in many countries throughout the world.</div>
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Malaysia has been the leading country for Takaful progress through the introduction of several dedicated</div>
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Takaful regulations allowing the cooperative insurance industry to have a high growth rate in that country</div>
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[17]. This approach was followed by other countries primarily in Islamic countries and countries with a large</div>
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Muslim community including: Indonesia, Brunei, Singapore in the Far East and Saudi Arabia, Bahrain, Iran,</div>
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Qatar in the Middle East. Recently, takful has also been introduced in UAE, Kuwait, Egypt, Bangladesh and</div>
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in non-Islamic countries such as Sri Lanka, Belgium, US and Canada. Main global presence of takful in the</div>
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world is mainly in Saudi Arabia (27%) Malaysia (34%), and Indonesia, Bahrain and UAE (5%) [7, 15, 16,</div>
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18]. The growth of number of Takaful companies reached 26% per year for the period 2006-2010. In this</div>
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regard, it is worth noting that Takaful contribution reached US$2.2 billion and by 2015, and it is estimated</div>
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that Takaful contribution could approach US$11 billion, with a growth rate of roughly 11-15% per year [7,</div>
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15]. The estimate for global Takaful assets is about 15$ billion by 2015. [15] This shows clearly that there is</div>
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a tremendous opening for Takaful to develop worldwide, and with more introduction of Takaful regulations</div>
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and investments, Takaful industry is expected to become a healthy and growing industry and strongly</div>
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competes with the conventional insurance business.</div>
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<b><span style="color: red;">4. Saudi Cooperative Health Insurance Act and Laws:</span></b></h3>
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Insurance in the Kingdom of Saudi Arabia was first regulated by the provisions of the articles of</div>
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incorporation of a national company for cooperative insurance issued by Royal Decree No (M/5) on 1985.</div>
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This laid the base to start insurance industry by insurance companies registered in the Kingdom and</div>
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operating in accordance with the practice of cooperative insurance and not inconsistent with the provisions of</div>
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Shariah. In 1999, the Cooperative Health Insurance Act was issued by a Royal Decree to launch a new</div>
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health insurance program, aimed at covering ultimately the whole Saudi and non Saudi population. This new</div>
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program is based on ‘Takaful’, or Islamic insurance concepts. The Cooperative Health Insurance act consists</div>
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of nineteen articles and aims to first regulate the provision of health care for non-Saudi residents in the</div>
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kingdom, and later on, after specified time phases to be applied to Saudi Citizens. [13] The act made the</div>
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health insurance compulsory, with anyone sponsoring a non- Saudi resident shall be obliged to participate in</div>
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the cooperative health insurance for the benefit of the resident and by attachment of the residence permit</div>
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issuance and renewal to fulfilling a cooperative health insurance policy. The Cooperative Health Insurance</div>
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act also established the Cooperative Council for Health Insurance (CCHI) to supervise the implementation of</div>
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the cooperative health insurance act. The main tasks of the CCHI include: the preparation of the act</div>
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executive bylaws, certification of the cooperative insurance companies, accreditation of “private & public”</div>
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health care providers centres, and the definition of the cooperative insurance financial regulation and fees.</div>
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[19] The act also defined a health insurance policy that covers the basic health services. These services do</div>
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not however prejudice the requirements of the social insurance regulations nor with health services offered</div>
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by private companies, institutions and individuals to their employees in excess of those provided by this act.</div>
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Following the promulgation of the cooperative insurance act, the rules of implementation of the</div>
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cooperative health insurance system and the details of cooperative health insurance policy was issued by</div>
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Minister of Health Resolution No. 460/23/DH on June 2002. [20] On July 2003, a Royal Decree No M/32</div>
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approved the control law of cooperative insurance companies. This law complements the Cooperative Health</div>
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Insurance Act and aims towards controlling insurance and re-insurance activities and to regulate and approve</div>
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rules for cooperative insurance companies’ establishment and licensing in the kingdom. The Saudi Arabian</div>
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Monetary Agency (SAMA) was assigned the power of technically supervising the implementation of the</div>
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insurance control law. SAMA main task is to guarantee that insurance companies satisfy the conditions and</div>
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the rules applicable in this respect [21]. On 10/2002 the council of Ministers passed a resolution for the</div>
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enforcement of the Cooperative Health Insurance Act on Saudi citizens working with companies, private</div>
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establishments or individuals. Finally, On May 2009, based on CCHI resolution, the executive bylaws of the</div>
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cooperative insurance act and the terms of a unified standard policy was declared in a ministerial decision by</div>
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the minister of health [22].</div>
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<b><span style="color: red;">5. Challenges and Achievements:</span></b></h3>
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In this section, we are interested in reviewing the application of this new Islamic insurance scheme and</div>
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what are the factors that contributed to its success or failure. In the positive side, as a result of health</div>
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insurance act, since 2007, health insurance became the largest line of insurance business. At that year it</div>
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accounted for 36% of total gross written premium (GWP) and 43% of total Net Written Premiums (NWP)</div>
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in 2007 [19, 23]. By early 2011, and after five years from the date of health insurance implementation on</div>
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15/07/2006, there are 8.3 million health insured individuals, 2,147 Health Care Providers accredited, and 26</div>
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Health Insurance companies certified [19,23]. Recent economy survey into the Saudi insurance sector</div>
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revealed that the sector will create between 35,000 to 40,000 job opportunities over the coming decade. [19,</div>
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23]. This survey results also revealed that, the sector itself will be worth US$18 Billion by 2016. [19]</div>
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The most drawbacks of the kingdom experience with insurance solutions are quite similar to the</div>
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experience of developed countries that have preceded the kingdom in implementing commercial health</div>
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insurance. Continuous increase of health care cost due to the large demand for health care encouraged by the</div>
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insurance sector and the relatively small number of certified insurance companies. The prices of various</div>
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health services have continuous rises (5-10%) yearly in the value of insurance premiums depending on the</div>
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types of services covered [19]. Other drawbacks is lack of compliance with the Shariah laws by many</div>
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insurance companies, due to the absence of regulatory bodies and accurate information data and</div>
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transparency of the cooperative insurance practice, which resulted numerous disputes, fraud and abuse of</div>
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insurance policies by all parties involved.</div>
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<span style="color: red;">6. Conclusion:</span></h3>
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The Kingdom’s experiment with health insurance is relatively new and full of challenges. Takaful health</div>
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insurance in Saudi society contributed relatively moderate positive impact on certain sectors of Saudi</div>
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economy, namely insurance industry, private health care business and job market. However, several negative</div>
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fallbacks also occurred which call for reconsidering other additional solutions for funding health care</div>
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services</div>
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Speaking at the symposium entitled “Health Insurance Conference – Options & Prospects” organized by</div>
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the Ministry of Health on 2011, the Saudi Minister of Health pointed out that the main aim of applying</div>
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cooperative health insurance in the Saudi kingdom is to improve and develop the health sector according to</div>
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the sound principles of Islamic religion and culture without burdening the citizens, as is the case in many</div>
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other countries. He also stated that there should be more efforts to identify the concept, the purposes and the</div>
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consequences of insurance, to differentiate between commercial health insurance and cooperative health</div>
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insurance, and to know that the concept of insurance is not necessarily associated with the privatization of</div>
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the health sector. The experience of developed countries demonstrated clearly that the implementation of</div>
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commercial health insurance and the privatization of the health sector, led to increasing costs of healthcare”</div>
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[24].</div>
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In our opinion, the relatively short experiences of the Saudi health sector demonstrated the strong need to</div>
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a comprehensive public health insurance coverage. With the respect to Takaful insurance sector , our</div>
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opinions is that the application of cooperative health insurance noble principles can assist in reducing</div>
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health care cost if this sector is re-structured and regulated.</div>
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<b><span style="color: red;">7. References:</span></b></h3>
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[1] Ali, Kasi Md. Mortuza, 1989. “Principles and Practices of Insurance under Islamic Framework,” Insurance Journal,</div>
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(December): 29-38.</div>
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[2] Bank Negara Malaysia. (2005). 20 Years Experience of Malaysian Takaful Industry. Bank Negara Malaysia.</div>
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[3] Bhatty, Ajmal , “The growing importance of Takful Insurance “ , Asia regional seminar , OCED and bank of</div>
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Negara , Kuala Lumpure , 22-24 September , 2010</div>
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[4] Dawood, Yousef Taylor, “Takaful in the new millennium Where are we now? Where do we go from here?” ,</div>
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Takaful articles , Number 1: ICMIF , August 2005</div>
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[5] Habshi, Syed Othman, 1997. “Takaful – A Suitable Alternative for Contemporary Economy,” Labuan</div>
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International Summit on Takaful, June 19-20, Labuan, Malaysia.</div>
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[6] Kahtani, Ali Ayad “Experience of Mandatory Health Insurance in Kingdom of Saudi Arabia”, Presentation of</div>
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Compulsory Medical Insurance Workshop, Bahrain Insurance Association 12-13 OCT 2008, Bahrain.</div>
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[7] Maysami, Ramin Cooper, 1998. “Islamic Insurance: Sudan to Singapore,” Asian Business Law Review,19</div>
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(January): 62-68.</div>
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[8] Maysami, Ramin Cooper and W. Jean Kwon, “An Analysis of Islamic Takaful Insurance--A Cooperative</div>
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Insurance Mechanism,” Journal of Insurance Regulation, Vol. 18, No. 1, Fall 1999, pp. 109-132.</div>
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[9] Marcel Omar Papp , "Understanding Takaful/reTakaful" , Swiss Re Zurich Company – Retakaful Branch,</div>
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Research Report, October 2010</div>
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[10] Mohamad Abdul Hamid, Mohd Sukki Othman, "A Study on the Level of Knowledge and Understanding Among</div>
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Muslims Towards the Concepts, Arabic and Shariah Terms in Islamic Insurance (Takaful)", European Journal of</div>
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Social Sciences – Volume 10, Number 3 (2009).</div>
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[11] Norlida AM, Rosemaliza AR, Yusnidah Ibrahim. 2004. Awareness and Ownership of Family Takaful Scheme</div>
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Among Muslim Community in Malaysia. The Journal of Muamalat and Islamic Finance Research (JMIFR) Vol.</div>
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1/No. 1: 121-136</div>
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[12] Penland, Claude, Recent Trends in Takaful, Casualty Actuarial Society, World Wide Web :Casualty Actuarial</div>
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Society site : (www.ClaudePenland.com)</div>
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[13] Proceeding of the 3rd International Islamic Banking , Finance & Insurance (TAKAFUL) Conference "Islamic</div>
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Banking, Finance & Insurance (Takaful) in North America: Opportunities & Challenges“ Ottawa Congress Centre,</div>
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Ottawa, Canada May 2007</div>
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[14] Rabeah, Abdullah, Conference opening ceremonial speech , Health Insurance Conference – Options & Prospects”</div>
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Ministry of Health on 2011 , the Saudi Minister of Health April 2011,</div>
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[15] Sharif, Abdullah I., Secretary General Council of Co-operative Health Insurance,” Health System and Insurance</div>
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In Saudi Arabia ” , BHF Southern African Conference , July 2008</div>
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[16] Sharif, Abdullah I., Secretary General Council of Co-operative Health Insurance , “Compulsory Health Insurance</div>
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Way Forward” ,Health Insurance Conference –“ Options & Prospects” Ministry of Health , April 2011</div>
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[17] Usmani, Imran, “Takaful : the Islamic insurance” Securities and Exchange Commission of Pakistan (SECP )</div>
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Takaful Conference , Karachi , March 14, 2007</div>
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[18] Cooperative Insurance Companies Control Law, Royal Decree No M/32 , July 2003, (2 Jumada II 1424)</div>
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[19] The First Annual Report For the Year 1428H (2007G), Cooperative Health Insurance Council, Ministry of Health ,</div>
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Riyadh Saudi Arabia ,2007Jiang, R. Fan. Recognition of Biological Signal Mixed Based on Wavelet Analysis.</div>
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[20] The Second Annual Report For the Year 1429H (2008G), Cooperative Health Insurance Council, Ministry of</div>
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Health , Riyadh Saudi Arabia ,2008</div>
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[21] The Third Annual Report For the Year 1430H (2009G), Cooperative Health Insurance Council, Ministry of</div>
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Health , Riyadh Saudi Arabia ,2009</div>
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[22] The Cooperative Health Insurance Act, Royal Decree no: M /10 on August 1999. (1/5/1420 H)</div>
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[23] Rules of Implementation of Cooperative Health Insurance system, & cooperative health policy, Ministry of health</div>
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Resolution No. 460/23/DH , 1423</div>
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[24] Implementing Regulations of the Cooperative Health Insurance Law in the Kingdom of Saudi Arabia (Amended).</div>
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Cooperative Council for health insurance Session No. (73), Ministerial Decision No. DH/1/30/6131 , 08/06/1430H</div>
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[25] World Wide Web : www.cchi.gov.sa (Council of Co-operative Health Insurance), July 2011</div>
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[26] World Wide Web :www.moh.gov.sa ( Ministry Of Health) July 2011</div>
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[27] World Wide Web :www.cdsi.gov.sa ( Central Department for Statistics and Information) July 2011</div>
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[28] World Wide Web :Casualty Actuarial Society (www.ClaudePenland.com) June 2010</div>
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[29] World Wide Web :Institute of Insurance and Risk Management (IIRM) (www.iirmworld.org.in)</div>
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[30] www.kantansurance.htmkji.com/fiqh/I May 2010</div>
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[31] www.eventscom.net/bia/presentation.htm (Compulsory Medical Insurance Workshop , Bahrain) ), July 2011</div>
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Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-828977695664493093.post-91289704697162638062012-11-28T16:13:00.002-08:002012-11-28T16:23:10.709-08:00The Takaful Insurance and a Brief Reviewing in Latin America<div dir="rtl" style="text-align: right;" trbidi="on">
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Introduction</span></h2>
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Starting the 1970s and increasingly in the 1990s, Islamic countries and other countries with a significant Muslim population have encouraged the provision of financial services, including insurance, under Islamic principles. As a result, a number of Islamic insurance companies, called Takaful insurers, have been established to provide Muslim individuals and businesses with insurance coverage both in the life and non-life sectors (Field Research, 2011).</div>
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Currently, there are about seventy “Takaful” operators world-wide. During last twenty seven years Islamic Insurance (Takaful) has developed mainly in Sudan, Egypt, Saudi Arabia, Iran, Kuwait, Lebanon, Malaysia, Brunei, Indonesia, Singapore, U.A.E., Bahrain, Bangladesh, Nigeria, Tunisia, Bahamas, Belgium, South Africa, Switzerland, Australia and in the USA. Interestingly Takaful is seen in the non-Muslim world as well. For example, in Singapore there are less than half a million (15% of total population) Muslims but at least two operators are now providing Takaful scheme in Singapore. In non-Muslim countries, the scheme is also likely to grow if the operators can prove their worth in comparison to conventional insurance products. In Muslim countries, Malaysia seems to be the single most successful country in terms of Takaful. In Singapore, about 22% of the present Takaful policy holders are non-Muslims (Mortuza, Ali; 2009:10 and Field Research, 2011).</div>
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In European countries, the particular case of the United States, and in a smaller scale in Latin America, there has been an important increment in the Muslim population and therefore a big increment in Islamic financial institutions -banking system- that offers financial products to meet the needs of the Muslim population with different characteristics from the ones offered in the Conventional System, meeting the demands of the Muslim population in these countries.</div>
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Consequently a new interest arises -in Latin America especially -, an deep interest in the way these markets and their products operate, the interest being such that the Islamic Financial System and its products, in this case the Takaful, can become a financial option or with parallel coverage as the regular financial options and conventional insurances already existent, especially for the Muslim population in these countries and the access to the same by the non Muslim population.</div>
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Kooper and Kwon (2000) indicated that as result of this growth process in the Muslim community in many countries around the world, many companies, especially in the United States, and other non Muslim countries in Europe such as United Kingdom and France, have been including financial services related to insurance field or financial products for the Muslim market.</div>
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The importance of the diversification in the markets and financial products, especially those related to the Islamic System, the growing interest from non Muslim companies and individuals to understand the dynamic of these products and how to gain access to them, and last but not least, the existence in Europe, United States, and Latin America of an important and continually growing number of Muslim communities in need of the offering of financial tools -according to their religious principles-, conform an important base for the elaboration of this document. The study in this field is made with the goal in mind of understanding why a new product like Takaful could be developed in Latin America, especially to attend the needs of the Muslim community, but also to make it a future option of financial cooperation with social sense, parallel to the existent Conventional Finance System and accessible to the Latin American non Muslim Community that wishes to use the product.</div>
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This document in first instance presents a general explanation about the Takaful, especially its origin and importance, followed by a general approximation –due to lack of information- to the development of the Takaful in Latin America. Continuing with a description of the Muslim community in Latin America, and later why is important to develop the Takaful in Latin America for the Muslim community as well as the non Muslim population, finally conclusions on the matter.</div>
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2.Brief Background</span></h2>
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2.1.Takaful principle approach</span></h3>
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With the establishment of the Dubai Islamic Bank and the Islamic Development Bank, as the starting point of Islamic Banking Movement, H.E. Prince Mohammed-El-Faisal-Al-Saud of Saudi Arabia took initiative for the establishment of a number of Islamic Banks. In one of such initiatives in February, 1976 he held discussions with H.E. Gafar Nimeiry (the then President of the Democratic Republic of Sudan) and asked for permission to establish an Islamic Bank to be operated in Sudan. Executive and Legislative authorities in the Sudanese Government at all levels gave every encouragement and acceded to the proposal (Mortuza, Ali; 2009:5).</div>
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When Faisal Islamic Bank was established, the Bank authorities initiated studies on the establishment of a co-operative insurance company. In this respect the opinion of the Bank’s Shariah Supervisory Board (S.S.B) was sought. The S.S.B studied the case at the first meeting. Studies continued and several steps followed. The Memorandum of Association and Articles of Association were prepared by the Faisal Islamic Bank authorities. The S.S.B proposed some amendments which were implemented. The S.S.B ensured that the scheme was sound from Shariah point of view as well as feasible from practical point of view. Consequently, the Islamic Insurance Company Ltd Sudan was incorporated as a Sudanese Public Company (under the Companies Act 1925) in January 1979 (Mortuza, Ali; 2009:5).</div>
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Mortuza (2009) mentioned this is the first ever insurance company established in the world to transact business according to the Islamic Shariah. The entire authorized capital of this company was subscribed to by the Faisal Islamic Bank. The company was allowed numerous concessions and exemptions. All its assets and profits were exempt from all types of taxes. Further, the assets of the company are not subject to confiscation, nationalization etc. The company is also exempt from the application of The Acts regulating insurance in Sudan.</div>
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In recent decades, many Islamic countries have found that insurance plays a crucial role in furthering their economic developments and, even in some of those countries; Western (non-Islamic) insurers are allowed to underwrite risks. A few local insurance companies were also incorporated in selected countries. Yet, it seems somewhat remote that Muslim communities would accept broadly the Western concept of insurance because it does not conform well to several Islamic principles. They instead have developed a new concept of insurance that complies with Islamic principles, called Takaful insurance (Kooper and Kwon; 2000:2-3).</div>
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This is a type of joint guarantee insurance mechanism based on the law of large numbers in which a group of societal members pool their financial resources together against certain loss exposures. Takaful insurance is now popular in many, yet not all, Islamic countries as well as in other countries with a significant Muslim population, e.g., Brunei, Indonesia, Malaysia and Singapore. Interestingly, Takaful arrangements are also found in Luxembourg and Switzerland and, recently, in the US, Australia. Growth is forecast to be especially rapid after the turn of the century (Kooper and Kwon; 2000:3).</div>
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The idea of having Shariah based insurance system (Takaful) stems from the earnest desire of the followers of Islam to conduct their affairs in day to day life according to the teachings of Islam and within the framework of Islamic Law. Takaful is based on the concept of cooperation, brotherhood and solidarity of the members of the society who voluntarily agree to contribute money to support a common goal of providing mutual financial aid to the members of the group under certain terms and conditions (Mortuza, Ali; 2009:2).</div>
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Currently, Takaful has emerged as a complementary and supportive system of Islamic Banking movement throughout the world. Islamic Insurance (Takaful) like Islamic Banking has become a viable reality. Due to inherent Sharia principles which are universal in character, the Takaful business would be more appealing in the coming years both for the Muslim and non Muslim communities. Most of the Muslim countries having Islamic Banks have established Islamic Insurance companies as necessary complements to Islamic Banking. The growth of Islamic Insurance companies would serve as the vehicle of risk pooling. It will also provide means of investment (Motuza, Ali; 2009:2).</div>
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More than seventy Takaful/Islamic Insurance companies have been established for providing insurance coverage both in the life and non-life sectors. These insurers generally known as Takaful operators are found not only in Islamic countries but also in Europe, North America and Australia. This type of modified insurance mechanism is expected to further influence the supply of and demand for insurance in the Muslim community (Mortuza, Ali; 2009:6).</div>
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2.2. Takaful Insurance in Latin America</span></h3>
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In the case of Latin America, information regarding Islamic Finances and specifically the implementation of products like the Takaful is extremely difficult to find. There are only a few documents written with this regard and the informational resources don’t have a valid source that allows us to make a trustworthy analysis on the subject.</div>
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In a region with few Islamic financial institutions like Latin America -particularly Takaful firms- it is surprising that different institutions consider a move into the Latin America Takaful market. For instance, BestRe2, the reTakaful subsidiary of Dubai-based Salama with most of its business in East Asia, is planning expansion into South America. Now, the timetable for this expansion is some ways off -5 to 7 years. BestRe’s general manager its HQ in Tunisia, Riadh Karray, confirmed that the company’s timeline for its South American expansion depends on the growing Takaful industry expanding to meet demand from Muslims in countries with larger Muslim minorities, either Guyana, Surinam and French Guyana or Brazil and Argentina which have the largest total number of Muslims in South America3. AIG as a worldwide insurance company -as well as BestRe- have presented the need of promoting Takaful insurances in Latin America, however is not a real project at the moment.</div>
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The Shariah Fortune4 in their website indicates that in Latin America, the Takaful can be found in Brazil. The company is ACE Latin America, located in Sao Pablo and it’s the provider of Takaful insurance in the country. Also in Sao Pablo, the Bank of Tokyo-Mitsubishi UFJ, Ltd. No more records were found in Latin America of other companies or banks that offer Islamic products like Takaful Insurance.</div>
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2.3. Muslim Population in Latin America</span></h3>
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Islam is the second largest religion in the world with one and quarter billion followers. In all, Muslims form a majority of the population in over forty countries. Muslims live in 184 countries comprising about 20 percent of world population (Mortuza, Ali; 2009:6).</div>
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In Africa, Islam is the second most dominant religion after Christianity and over 40 percent of the population is Muslim. In Asia, where Islam is again the second most popular religion after Hinduism, over 20 percent of population abides by Islamic principles. Muslims also comprise approximately 4 percent of the European population. In the US, the number of Muslims has grown from more 10,000 in 1900 to over 4.8 million in 1997. All in all, 1.12 billion Muslims live in 184 different countries, comprising about 19.4 percent of world population in 1996.</div>
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In Latin America, from the beginning of the second half of the 20th Century, the Islam recovered the expansive power from the mediaeval age, concentrated on reaffirming their traditional territories, all the while it begins an expansion to regions traditionally non Muslim, among others Latin America. Even with the presence of Muslim since the colonization times, the Islam has never presented Latin America as an objective since its expansion until the end of the 20th century. (Andrade, Gabriel; 2001:119)5.</div>
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For the “Organizacion Islamica para America Latina” (OIAL), the arrival of the Islam to America is just as ancient as the region itself. Since the discovery of America by the Spaniards in the XV century, the slaves, brought by the conquerors from the north and west of Africa, introduced the Islam, they settle down in countries like Brazil, Venezuela, Colombia, and some islands of the Caribbean. A big majority of these slaves were Muslims, who did not have the freedom of practicing their own religion. Therefore with time the remains of the Islam started disappearing from Latin America.</div>
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The OIAL (2011), have calculated that Brazil and Argentina are the countries with more Muslim presence. Also there has been immigration of Arabian communities to Venezuela, Colombia and Paraguay. The majority is Syrian and Lebanese’s (Christian and Islamic). In Costa Rica is calculated that the number of Muslim families could be around 2006 (around 1200 people).</div>
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It’s calculated that the Muslims in Latin America are around 6 and 7 million, according to data for 2006. The groups are the Sunnis, the Chita’s, Orthodoxies, the Marnoites, the Sufis and the Druze. The specialists agree that the numbers on the Arabian presence and Muslim in Latin America are very confusing and diverted. The first mosque in Argentina was built around 1986, Carlos Menem, ex-president of Argentina was a descendent of a Muslim family from Syria that got converted to Christianity. Others such as Abdala Bucaram, was a president of Ecuador and he was descendant from Libya. Gabriel Turbay, presidential candidate in Colombia in the forties, was Lebanese, and the famous Architect Alejandro Christophersen from Uruguay had Muslim origins. In Brazil alone there are 40 mosques with 36 Islamic organizations7. There are registries of the new construction of the new mosque in Panama, as well as the advances in the possible construction of a mosque in Costa Rica.</div>
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There was also a significant financial support from countries like Qatar, Saudi Arabia and Kuwait. These countries have invested around 20 million dollars to build major mosques and Islamic centers in Latinamerican major cities like Buenos Aires, Mexico City, Caracas and Lima (LAMU, 2009 en Andrade, Gabriel; 2001:127).</div>
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In the Central America case, surnames such as Kattan, Handal, Siman, Salume, Canahuati (Qanawaiti) Frech, Hasbun, Samara, are famous on the economic and political elite more powerful in the region. Some, like Carlos Roberto Flores from Honduras, and Antonio Saca in El Salvador have become presidents of these countries -although the story has been the most successful Mexican billionaire Carlos Slim, one of the world's millionaires entrepreneurs-. Palestinians also came to Nicaragua, and have had much influence in the life of the country. Nicaragua opened the first and only diplomatic representation of the Palestine Liberation Organization (PLO) for the entire region. The same happened in Panama, Guatemala and Belize, where there are strong communities of Palestinian origin, such as the rest of Central America, have been integrated and mixed with the rest of the Central America population8.</div>
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In the Costa Rica case, the Muslims arrived around 1887. Mostly Lebanese in isolation, and in successive waves -and such as the Palestinians-, fully integrated into the economic, political and cultural life. It was a descendant of Lebanese, Miguel Barzun, who founded in 1976, the “Bolsa de Valores de Costa Rica”9.</div>
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However, despite the growing importance of Muslim communities, and native increasing who adopt the Muslim religion in Latin America, it is clear that countries that support the expansion of Islam, especially in economic and financial terms have been to Latin America on the second place, especially since these strategies have expanded more strongly in the U.S. and Western Europe.</div>
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<span style="color: red;">3. Takaful Insurance importance for Muslims and Non-Muslims Communities in Latin America</span></h2>
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In the Latin American case, the Banking System is an essential element of the reproduction of capital. In this regard, the Banking Credit System uses the mechanism of interest charges on loans granted to Banks, which eventually generates capital gain. In Islamic System, the capital as an instrument can’t produce more capital, unless it is associated with a certain type of production. The “usury” prohibition from Islamic System has recently become an option to appeal the vast majority of Latin Americans, both Muslims and no-Muslim population (Andrade, Gabriel; 2001:123).</div>
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The banking system is an important channel to develop products such as Takaful. In Latin America the Conventional Banking System prevail, and the possibilities of offering Islamic products has been almost impossible for many years, especially with the latinamerica conutries conditions, and religious principles underlying the Islamic Financial System. Those are very differents from the Conventional Banking System. In addition, has not been also a demanding application of this system in the region except in Brazil where -as noted above-, there is already Takaful Insurance market.</div>
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The situation in Latin America has been very different than happened in Europe or United States. Important efforts have been during recent years in Latin America, but not yet consolidated. For instance, in the banking system, there are advanced talks about the importance of guidelines establishing that contribute to the development, throughout the region, the Islamic Banking System, and Takaful Insurance. Brazil, Argentina and Panama, have been most concerned to advance on these issues10. This would facilitate greatly the development, not only of products such as Takaful, but other Islamic Financial products. Importantly, Brazil has advanced greatly in the implementation of Islamic Financial Institutions, and financial products like Takaful Insurance.</div>
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According to Mortuza (2009), the Takaful is based on the concept of cooperation, brotherhood and solidarity of the members of the society (as important principles of Islamic Law) who voluntarily agree to contribute money to support a common goal of providing mutual financial aid to the members of the group under certain terms and conditions. The objective of Islamic Economic system is the promotion of welfare of people which lies in safeguarding their faith, their life, their posterity and their property. By ensuring and safeguarding these elements of the people, Takaful serves public interest and, therefore, can play the most important role.</div>
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Based on the words of Mortuza (2009), the Takaful Insurance in Latin America could become to expand the universe of possibilities in the insurance sector, especially by providing a differentiated product based on cooperation and solidarity principles of society. More Muslims in Latin America would be able to access this system. In addition, more non-Muslim population of Latin America would have the opportunity to learn the system, and to expand their opportunities for choice between a Conventional Insurance, and Takaful Insurance.</div>
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Mortuza (2009) also metioned Takaful is an alternative form of conventional insurance based on the concept of trusteeship and cooperation inspired by the beliefs of the followers of Islamic teaching. Muslim societies in different parts of the world are now practising Takaul scheme as their own way of sharing financial responsibilities to assist each other. They have invented an Islamic way of mutual assistance to deal with uncertainties of life. Takaful is a service to Muslim Ummah (community) as a welfare scheme. Introduction of Takful is an example as to how the principles of Islamic Shariah can help to create new socio-economic mechanism based on equity, justice and fair play.</div>
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Takaful is a social scheme based on the principles of brotherhood, solidarity and mutual assistance. It provides mutual financial aids and assistance to those who are members of the takaful scheme and voluntarily agree to contribute a certain amount of money for that purpose. It is a mutual agreement among the participants of the scheme. This has its origin from the concept of collective sharing of individual’s loss. Takaful, is being practised now as an alternate of conventional insurance system and is bounded by Islamic principles, rules and the law of Islam -Shariah- (Mortuza, Ali; 2009:2).</div>
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Being a social framework based on the principles of brotherhood, solidarity and mutual assistance as Mortuza points (2009), Islamic finance in general, and specifically the Takaful could become an important tool in social terms in Latin America. Disadvantaged groups, especially those in agriculture and rural areas, have been desperate for new alternatives, strategies and / or more accessible social and financial programs. Recent studies indicate that there is demand for Takaful products, especially micro-takaful -among the poors populations- to micro finance and insure their business, especially in the agricultural sector. However, coverage of these programs is limited by the trained personnel lack; the lack of awareness of the poor people of the importance of insurance, insurers and reinsurer’s lack, and the lack of appropriate regulation. Islamic laws allow the establishment of cooperative links between insurance companies and Takaful (not between cooperatives and commercial insurance companies) in order to contribute to greater coverage to the poor people socially excluded.</div>
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As an example of this, the first draft of Takaful –micro takaful-, the Agricultural Mutual Fund (Agricultural Mutual Fund) was established in Lebanon in 1997 to provide health insurance to the rural poor people. The scheme considers expenses not covered by the government program that pays 85 percent of hospital costs. Currently, the Fund operates in 180 communities and serving 23,000 members. Members can access it from any religion. Each insured family must pay $ 10 a month, but the communities cover the cost of the poor people who can not afford. Premiums are kept low because the health costs are low in Lebanon since the program is heavily subsidized by government.You may need to outline their premiums rise if the government withdraws or reduces its subsidy. It also requires an expansion of coverage beyond the rural areas, increased the technical assistance, and reinsurance to help them achieve sustainability (Nagarajan and Meyer; 2005:43).</div>
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Due to inherent Sharia principles which are universal in character, the Takaful business would be more appealing in the coming years both for the Muslim and non Muslim communities, especially in United States, Europe, and currently in Latin America as new option -especially for poors inhabitants-. Most of the Muslim countries having Islamic Banks have established Islamic Insurance companies as necessary complements to Islamic Banking. It has been estimated that total Takaful contribution (premium) is approximately 0.05% of total world insurance premium. The consumers demand for Shariah compliant products is increasing and a high level of demand for Takaful is being predicted by market observers. The Takaful industry is fast evolving and entering a stable development phase. It is now right time for the national regulators to provide supportive Takaful laws, rules & guidelines (Mortuza, Ali; 2009:2).</div>
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As clearly pointed Mortuza (2009), the importance of Islamic Financial System has increased in recent years around the world, but in the specific case of Latin America, the efforts should be made to increase the presence of financial sector and their products like Takaful.</div>
<div dir="ltr" style="text-align: left;">
Takaful, generally means joint guarantee. It is an understanding among a group of people (called the participants) who agree to reciprocally guarantee each other financially should any event (as defined in the contract) occur. The basic objective of a Takaful contract is to pay from a common fund, which is set up by the participants of the scheme. The fund thus created may be managed by the participants themselves or through professionals or by a registered Takaful Operator11. The fund is created by the equitable contributions of the participants (Mortuza, Ali; 2009:3). While it is still non-existent or underdeveloped Islamic Banking System in Latin America, which could be the main channel for products such as Takaful Insurance, is important to consider the future implementation in the region. For instance, the Islamic principles on which to base the Takaful, the growing population of Muslims world-wide, especially Latin America being an important region in number of Muslim inhabitants as well as non-Muslim community interest to know about the Takaful, and be able to access this type of financial products, are important elements to consider strengthening the idea that in the short term to generate studies which help to develop strategies for the inclusion of these and other Islamic Financial products worl-dwide, and especially in Latin America.</div>
<div dir="ltr" style="text-align: left;">
Few efforts have been made on this issue. The Shariah Fortune12 in their website indicates that the Takaful Insurane can be found in Brazil. The ACE Latin American Company, located in Sao Paulo, is a provider of Takaful Insurance in the country. Also can be found the Bank of Tokyo-Mitsubishi UFJ, Ltd in Sao Paolo. In the rest of Latin America, not able to obtain more records from other companies providers or banks that offer Islamic Financial products such as Takaful Insurance. Likewise, there are in Latin America around between 6 - 7 million Muslims accounted for until 2006, of which about 2 million are located in Brazil -about 33% of the total-, a large majority in Argentina and Mexico, likewise a significant number in other countries such as Uruguay, Venezuela, Panama, Costa Rica, El Salvador, Colombia, among other countries, which account for almost 67% of the total. Considering the Brazil case, has a Takaful operator that works in this country, it could indicate that around 67% of Muslims living in Latin America do not have the opportunity to access that Islamic financial products, but also these statistics are some references to see if it really is feasible the development of Islamic Financial System and Takaful Insurance in Latin America.</div>
<div dir="ltr" style="text-align: left;">
Key elements that make up the Islamic Financial System could support both Muslims and non-Muslims in Latin America. For example, the principles of brotherhood, cooperation and social integration, the system of sharing profits or losses or to provide money without charging interest would make the Islamic Financial products more attractive to the Latin American population, especially because the Conventional Banking System lost from many years ago the social component in their financials operations, especially for poor people. As mentioned Mortuza (2009),</div>
<blockquote class="tr_bq" dir="ltr" style="text-align: left;">
“Takaful has been designed to help and stabilize the financial situation of individuals, families and organizations. At the same time Takafukl operators can meet the financing needs of large projects, thereby helping the national economies by enlarging the set of feasible investment projects and encouraging economic efficiency. Takaful will definitely help to foster a more efficient allocation of capital and resources of Islamic countries, by way of promoting trade, commerce and entrepreneurial activities”.</blockquote>
<div dir="ltr" style="text-align: left;">
Finally, the Islamic Banking and Islamic Insurance system have tremendous potentiality and prospect. The successful launching and operation of Islamic banks and insurance has established the fact that banking and insurance without interest is feasible, viable, competitive and sustainable on the face of competition from the conventional interest based system. The gradual and successful globalisation of Islamic Banking and Islamic Insurance coupled with growing awareness of the people about its financial and social benefits makes it clear that the current century is going to be the century of Islamic banking and insurance vis-a-vis complementation of Islamic ideals for the betterment of the people at large and establishing equity & justice for all (Mortuza, Ali; 2009:13-14)</div>
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<h2 dir="ltr" style="text-align: left;">
<span style="color: red;">
Conclusions</span></h2>
<div dir="ltr" style="text-align: left;">
The document is a very general approach on a specific topic such as the Takaful Insurance. There are still many gaps to take and explain, especially because in Latin America such issues are poorly studied, and access to information is limited. Also the possibility of developing an Islamic Financial System or the Takaful Insurance System could be considered little or no currently feasible in many Latin American countries, except Brazil and other countries such as Venezuela, Argentina, Panama, Chile, Peru and Costa Rica, with greater openness in financial services issues.</div>
<div dir="ltr" style="text-align: left;">
The lack of information about the system structure and the principles on which it is based, and the benefits to be accrued for the Latin American population in general, are highly unknown. This reduces the Takaful System promotion in the region. In addition, other elements such as political barriers, economic model, cultural, religious system, and language, could further reduce the implementation in Latin America of the Islamic Finance System and Takaful Insurance System, however, those are some of the challenges. As I mentioned earlier, the Brazilian case could be studied and to seek possibilities for play on the rest of Latin America.</div>
<div dir="ltr" style="text-align: left;">
Based on the above, other more specific studies and other field’s researchs can contribute in the near future, to develop strategies to encourage the development of the Islamic Finance System and Takaful Insurance System in Latin America. The Takaful Insurance Principles like brotherhood, cooperation and solidarity in society would make a significant resource in a region as Latin America, with so many social and economic poblems. Likewise, the productive sectors, especially those with less access to Conventional Finance Systems, are urged financial tools and social coverage, consistent with the conditions presented.</div>
<div dir="ltr" style="text-align: left;">
The same as North America -specifically Canada and the United States- or Europe, where the Muslim community has grown, in Latin America also today there is a large Muslim community, somewhere between 6-7 million, which opens the possibility of studying the conditions that could make feasible the implementation of Islamic Financial System, in this case, the Takaful Insurance System.</div>
<div dir="ltr" style="text-align: left;">
The possibilities in Latin America there are other Financial Systems –such as Islamic Financial System- than the conventional Financial System, could be many, varied, and greatly strengthened. As I mentioned above, in Brazil there are efforts in this regard, and specifically ACE Latin America Company with the implementation of Takaful Insurance, which could facilitate the model replication in other countries in the region, and willing to adopt the new system. Also, discussions to expand this system in other Latin American countries has -notably Panama and Argentina-, been an important agenda item.</div>
<div dir="ltr" style="text-align: left;">
However, the information limited about Islamic Financial and Takaful Insurance, but mostly the policy, cultural, religious and language differences could make some barriers between new financial products -especially those from the Islamic Finance- and Conventional Financial products stablished in Latin America. Questions as: What? Why? and Who? may not be clear enough, refers to Islamic Finance in general, and specifically the Takaful Insurance in Latin America. However, the metioned above is the central challenge in relation to Latin America and the countries of the Islamic world to collaborate and support the idea to introducing these and other financial products in Latin America region.</div>
<div dir="ltr" style="text-align: left;">
Finally, it is an excellent opportunity to expand the size of Takaful market by addressing the need of the customers who have preference for this product. In a market place such as Latin America, the attraction of Takaful business be perceived not just for the fact that it is based on Islamic Shariah -for Muslim inhabitants in Latin America- but because it is better and fair system -both Muslim and no-Muslim population-. This aspect should be attractive to everyone, irrespect of any religious basis upon which the system stands initially. Considering these aspects, Takaful players in the market like Latin America should take appropriate measures on urgent basis, in order that the opportunities are not missed by one or other reasons.</div>
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<div dir="ltr" style="text-align: left;">
<br /></div>
<h2 dir="ltr" style="text-align: left;">
<span style="color: red;">Bibliography</span></h2>
<div dir="ltr" style="text-align: left;">
<br /></div>
<ol dir="ltr" style="text-align: left;">
<li>ANDRADE, Grabriel, E. (2001). Posibilidades del Crecimiento del Islam en América Latina : oportunidades y dificultades. Universidad del Zulia. Revista Opción, Venezuela.</li>
<li>ALDIB, B (2000). The Quran and the Sunna. En http:/www.unn.ac.uk/socities.islamic</li>
<li>GARCIA, N; Arenas, O. (1986). Algunas nociones acerca de la religión. Opción.5:106- 111</li>
<li>HAMMIDULLAH, M (1969). Introduction to Islam. Centre Culturel Islamique. Paris (Francia).</li>
<li>MORTUZA, Ali (2009). Present Scenario and Future Potentials of Takaful. Managind Director of Prime Islamic Life Insurance Ltd.</li>
<li>BANK Negara Malaysia (Central Bank of Malaysia). Takaful 2005 Annual Report. April 2006.</li>
<li>BILLAH, Mohammad Masum (2001). Conceptual framework & Growing Principles of Takaful - Seminar paper in Sanghai held in 2001.</li>
<li>BILLAH, Mohammad Masum. (1998). Islamic Insurance: Its origins and Development. Arab Law quarterly 1998</li>
<li>NAGARAN, Geetha y Richard L. Meyer (2005). “Rural Finance: Recent Advances and Emerging Lessons, Debates, and Opportunities.” (Finanzas Rurales: Avances Recientes y Lecciones Emergentes, Debates y Oportunidades) Versión traducida y reformateada del Documento de Trabajo Nº (AEDE-WP-0041-05), del Departamento de Agricultura, Medio Ambiente y Economía del Desarrollo, de The Ohio State University (Columbus, Ohio, USA).</li>
</ol>
<div dir="ltr" style="text-align: left;">
<br /></div>
<div dir="ltr" style="text-align: left;">
<b>Internet websites</b></div>
<div dir="ltr" style="text-align: left;">
Organización Islámica para América Latina. http://www.webislam.com/?idn=3798</div>
<div dir="ltr" style="text-align: left;">
http://www.islamerica.org.ar/oipal.htm</div>
<div dir="ltr" style="text-align: left;">
http://www.hispanicmuslims.com/articles/spanishummah.html</div>
<div dir="ltr" style="text-align: left;">
http://news.bbc.co.uk/hi/spanish/specials/newsid_4294000/4294241.stm</div>
<div dir="ltr" style="text-align: left;">
http://www.prensalibre.com/pl/domingo/archivo/revistad/2005/junio05/050605/dfondo.shtml</div>
<div dir="ltr" style="text-align: left;">
http://www.diariocolatino.com/reportajes/detalles.asp?NewsID=34</div>
<div dir="ltr" style="text-align: left;">
http://spanish.nicaragua.usembassy.gov/rfp-nicaragua-2004.html</div>
<div dir="ltr" style="text-align: left;">
http://www.islamhoy.org/principal/lugares/lugares/14_peru/23-peru.htm</div>
<div dir="ltr" style="text-align: left;">
http://espanol.geocities.com/ommuruguay/inmigracionlibanesa.htm</div>
<div dir="ltr" style="text-align: left;">
http://www.jamestown.org/terrorism/news/article.php?articleid=2369844</div>
<div dir="ltr" style="text-align: left;">
http://spanish.irib.ir/elsur/noticias/islam-en-america-latina/item/75337-arabes-en-centroam%C3%A9rica-una-historia-de-inmigraci%C3%B3n-exitosa</div>
<div dir="ltr" style="text-align: left;">
http://panama.aigpyme.com/Inicio_478_66076.html</div>
<div dir="ltr" style="text-align: left;">
http://www.theislamicglobe.com/index.php?option=com_content&view=article&id=82:andale-arriba-arriba&catid=13:article&Itemid=38</div>
<div dir="ltr" style="text-align: left;">
http://mundomicrofinanzas.blogspot.com/2009_11_01_archive.html</div>
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<br /></div>
<div dir="ltr" style="text-align: left;">
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</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-828977695664493093.post-42021915819940471662012-07-22T07:55:00.002-07:002012-07-22T08:02:48.726-07:00HEALTH INSURANCE: GLOSSARY OF TERMS Part3 P-W<div dir="ltr" style="text-align: left;" trbidi="on">
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<div style="background: white; margin-bottom: .0001pt; margin: 0cm;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Paid Claims<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Amounts paid to providers based on the health
plan. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Paid Claims Loss Ratio <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Paid claims divided by total premiums. <o:p></o:p></span></div>
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<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Participating Provider <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">(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. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
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<a name='more'></a><br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Participation <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">The number of employees enrolled compared to the total
number eligible for coverage. LHSIC usually requires a minimum participation
percentage of 75%. Minimum participation percentages are no longer legally
required in Louisiana. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
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<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Peer Review <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Review of health care provided by a medical staff with
training equal to the staff which provided the treatment. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Per Member Per Month (PMPM )<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Refers to the cost to cover one member for one
month. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Pharmacy and Therapeutics (P&T) Committee <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A panel of physicians - usually from different
specialties - who advise the health plan regarding the proper use of
prescription drugs. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Pharmacy Benefit Manager (PBM)<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A managed care organization for prescription drug
benefits, using discounted pharmacy networks and utilization management to
control costs. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Physician Contingency Reserve (PCR) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A portion of the claim which is deducted and withheld
by the health plan before payment is made to the physician. It serves as an
incentive for proper quality and utilization of health care. A portion of this
reserve may be returned to the physician or to pay claims where the plan needs
additional funds. It is also sometimes called “withhold.” <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Point-of-Service (POS) Plan<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A health plan that is a “hybrid HMO” allowing the
covered person to choose to receive a service from a participating or
nonparticipating provider, with different benefit levels associated with the use
of participating providers. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Pre-Admission Authorization<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A cost containment feature of many group medical
policies whereby the insured must contact the insurer prior to a
hospitalization and receive authorization for the admission. LHSIC and HMOLA require
preauthorization for organ transplants. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Pre-Admission Certification <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A cost containment feature of many group medical
policies whereby the insured must contact the insurer prior to a
hospitalization and receive certification for the admission, as being medically
necessary and in an appropriate setting. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Pre-existing Condition <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A physical condition that existed prior to the
effective date of a policy. HIPAA and state law limit the time preceding the
effective date of a policy during which a condition exists to be considered
preexisting. In many health policies these are not covered until after a stated
period of time, called a “waiting period” has elapsed, usually one year. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Preferred Provider Organization (PPO) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An organization of contracts with hospitals and
physicians who provide services to insurance company clients. These providers
are listed as preferred and the insured may select from any number of hospitals
and physicians without being limited as with an HMO. The insured’s cost sharing
is less if he utilizes a PPO provider. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Premium Stabilization Agreement<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A financial agreement LHSIC offers to a fully insured
merit rated (100+) group, designed to allow a group to accumulate a source of
funds to offset future rate increases. The nature of the agreement is to define
a calculation of net ending financial results for a policy year. Should the
group terminate coverage, at the end of 15 months any remaining positive
balance after all expenses have been charged are returned to the group. Under
this agreement, premiums paid in excess of claims and administrative expenses
are accumulated in a fund, the balance of which can be used to offset rate
increases. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Preventive Care <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This type of care is best exemplified by routine
physical examinations and immunizations. The emphasis is on preventing
illnesses before they occur. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Primary Care <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Basic health care provided by doctors who are in the
practice of family care, pediatrics, and internal medicine. Louisiana law
requires insurers to recognize OB/GYNs as primary care physicians. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Prior Authorization<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Procedure used in managed care to control utilization
of services by requiring prior review and approval. Certain procedures or drugs
may require prior authorization. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Prospective Reimbursement <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A system where hospitals or other health care
providers are paid annually according to rate of payment which have been
established ahead of time. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Quality Assurance <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A formal set of activities to review and affect the
quality of services provided. Quality assurance includes quality assessment and
corrective actions to remedy any deficiencies identified in the quality of
direct patient, administrative, and support services. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Quality Improvement<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A continuous process that identifies problems in
health care delivery, tests solutions to those problems, and constantly
monitors the solutions for improvement. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Quality Improvement System for Managed Care (QISMC)<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An initiative backed by the Health Care Financing
Administration to improve the public health by developing a uniform quality
oversight system. The initiative addresses quality assessment and performance
improvement, enrollee rights, health services management, and delegation. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Reasonable and Customary Charges <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">The charge for medical services which refers to the
amount approved for payment. Customary charges are those which are most often
made by a provider for services rendered in that particular area. Sometimes
called “C&R.” <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Rebate<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A monetary amount that is returned to a payor from a
prescription drug manufacturer based upon utilization by a covered person or
purchases by a provider. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Referral <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Occurs when a physician or other health plan provider
receives permission to consult another physician or hospital. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Reinsurance<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Reinsurance is a transaction whereby one insurer,
usually for a fee or premium, agrees to indemnify another insurer against all
or part of a loss (risk) that the latter incurs under the insurance policies
that it issues. The indemnifying insurer assumes the risk and is known as the
“Reinsurer.” The insurer being indemnified cedes the risk and is known the
“Reinsured.” <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Relative Value Schedule <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A surgical schedule which basically compares the value
of one surgical procedure to another and establishes the surgical fee to be
paid. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Relative Value Unit <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Sometimes used instead of dollar amounts in a surgical
schedule, this number is multiplied by a conversion factor to arrive at the
surgical benefit to be paid. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Resource Based Relative Value Scale (RBRVS) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This is a classification system which is used to
determine how physicians will be compensated for services provided under
Medicare benefits. May be utilized by private insurers. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Restoration of Benefits <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A provision in many Major Medical Plans which restores
a person’s lifetime maximum benefit amount in small increments after a claim
has been paid. Usually, only a small amount ($1,000 to $3,000) may be restored
annually. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Retention <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">The portion of the premium which is used by the
insurance company for administrative costs. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Second Surgical Opinion <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A cost containment technique to help patients and
insurance companies determine whether a recommended procedure is necessary, or
whether an alternative method of treatment could accomplish the same result.
Some health policies require a second surgical opinion before specified
procedures will be covered, and many policies pay for the second opinion. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Section 125 Plan <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A plan which provides flexible benefits. This plan
qualifies under the IRS code which allows employee contributions to meet with
pre-tax dollars. Also called a Cafeteria Plan. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Self-Funded Plan <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Plan of insurance where an employer, which has fairly
predictable claim costs, pays the claims rather than an insurance company. See
also Administrative Services Only and Third Party Administrator. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Service Area <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">The area, allowed by state agencies or by the
certification of authority, in which a health plan can provide services. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Short-Term Disability Insurance <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A group or individual policy usually written to cover
disabilities of 13 or 26 weeks duration, though coverage for as long as two
years is not uncommon. Contrast with Long-Term Disability Insurance. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Split Dollar Coverage <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An arrangement of Disability Income Insurance in which
the employer and employee each pay a portion of the premium. The employer
purchases coverage for the sick pay or paid disability leave provided as an
employee benefit. The employee pays for disability coverage beyond what the
employer provides as a benefit. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Stop-Loss Insurance <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This is a type of reinsurance which can be taken out
by a health plan or self-funded employer plan. The plan can be written to cover
excess losses over a specified amount either on a specific or individual basis,
or on a total basis for the plan over a period of time such as one year. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Subacute Care<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An intermediate level of care provided to medically
fragile patients who are too ill to be cared for at home, but require medical
and nursing services at a higher intensity level than is offered in a typical
skilled nursing facility. Subacute care may be provided in long-term care
hospitals, hospital-based skilled nursing units, transitional, or intermediate
care units within community-based nursing facilities, as well as in certain
other settings. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Subscriber <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This term has two meanings - first, it refers to a
person or organization who pays the premiums, and second, the person whose
employment makes him or her eligible for membership in the plan. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Summary Plan Description<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This is a recap or summary of the benefits provided
under the plan. It is used most often with employees covered by self-funded
plans. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Supplemental Medical Insurance (SMI) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Part B of Medicare is a voluntary program which
generally covers physician’s services and various outpatient services. A
premium is charged for electing Part B coverage. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Tax Equity and Fiscal Responsibility Act of 1982
(TEFRA) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This act defines the primary and secondary coverage
responsibilities of the Medicare program and also the provisions to be used by
health plans in their contracts with the HCFA (Health Care Financing
Administration). <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Ten Day Free Look <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A notice, placed prominently on the face page of the
policy, advising the insured of his or her right to examine a health policy,
and if dissatisfied return the policy within ten days for a full refund of
premium and no further obligation. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Tertiary Care <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">Services provided by such providers as thoracic
surgeons, intensive care units, neurosurgeons, etc. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Third Party Administrator (TPA) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An entity that provides administrative services for
employers and other associations having group insurance plans. TPA’s usually
administer employer self-funded plans but may act as a liaison between an
employer and its insurer. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Third-Party Payor <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">This refers to any organization such as Blue Cross/
Blue Shield, Medicare, Medicaid, or commercial insurance companies which is the
payor for coverages provided by a health plan. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Trend Factor <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">The factor applied to rates which allows for such
changes as increased cost of medical providers, the cost of new and expensive
medical technology, etc. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Triple Option <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A plan where employees have their choice, among different
types of provides such as HMO, PPO, or basic indemnity plan. Usually, their
choice depends on how much they want to pay for the coverage. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Underwriting<o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">An insurer’s procedure for analyzing a group or
individual applicant to determine whether or not to offer insurance coverage
and, if so, at what price. Insurers weigh risk assessment and feasibility based
on an applicant’s past usage and health-risk factors. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Uniform Billing Code of 1992 (UB-92) <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A federal directive that states how a hospital must
provide their patients with bills, itemizing all services included and billed
on each invoice. The UB-92 is the standard bill submitted by hospitals to
insurers. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Utilization <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="font-size: 13.5pt;">A measure of medical service consumption. <o:p></o:p></span></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<br /></div>
<div style="background-color: white; background-position: initial initial; background-repeat: initial initial; margin: 0cm 0cm 0.0001pt;">
<span lang="EN-US" style="color: red; font-size: 13.5pt;">Utilization Review <o:p></o:p></span></div>
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<span lang="EN-US" style="font-size: 13.5pt;">A formal assessment of a patient’s course of treatment
to evaluate the appropriateness of care. <o:p></o:p></span></div>
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<span lang="EN-US" style="color: red; font-size: 13.5pt;">Waiting Period <o:p></o:p></span></div>
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<span lang="EN-US" style="font-size: 13.5pt;">The period of time between the beginning of coverage
and the start of benefits. In case of disability insurance, this is called an
“elimination period.” In health policies it means either (1) the time between
the effective date of coverage and the date benefits will be paid for a
pre-existing condition (“pre-ex waiting period”) or (2) the time between an employee’s
date of hire and the date on which he is eligible for benefits under his
plan. <o:p></o:p></span></div>
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<br /></div>newcamdservershttp://www.blogger.com/profile/11054975238236313257noreply@blogger.com0tag:blogger.com,1999:blog-828977695664493093.post-56289836633255272662012-07-22T07:41:00.001-07:002012-07-22T08:03:02.367-07:00HEALTH INSURANCE: GLOSSARY OF TERMS Part2 E-O<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: red;">Eligible Expenses</span><br />
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.<br />
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<span style="color: red;"> Eligibility Date</span><br />
The date that a person is eligible for benefits.<br />
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<span style="color: red;">Eligibility Period</span><br />
(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.<br />
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<span style="color: red;">Employee Retirement Income Security Act of 1974 (ERISA)</span><br />
Federal law governing administration of employee benefit plans and the rights of beneficiaries of the plans. These include the right to receive information on benefits and disposition of claims for benefit appeal rights. ERISA preempts all state laws relating to such plans except those regulating the business of insurance.<br />
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<span style="color: red;">Encounter</span><br />
Each occasion on which a person meets with a health care provider to receive services.<br />
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<span style="color: red;">Encounters Per Member Per Year</span><br />
The total number of encounters per year divided by the total number of members per year.<br />
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<span style="color: red;">Enrollee</span><br />
An eligible individual who is enrolled in a health plan.<br />
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<span style="color: red;">Enrollment</span><br />
Used to describe the total number of enrollees in a health plan. It may also be used to refer to the process of enrolling people in a health plan.<br />
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<span style="color: red;">Episode of Care</span><br />
Treatment rendered in a defined time frame for a specific disease. Episodes provide a useful basis for analyzing quality, cost, and utilization patterns.<br />
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<span style="color: red;">Evidence of Insurability</span><br />
The statement of information needed for the underwriting of an insurance policy. This could be an application containing health questions or an Attending Physicians Statement (APS).<br />
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<span style="color: red;">Exclusive Provider Organization (EPO)</span><br />
A type of preferred provider organization where individual members use particular preferred providers rather than having a choice of a variety of preferred providers.<br />
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<span style="color: red;">Expected Claims</span><br />
The estimated claims for a person or group for a contract year based usually on actuarial statistics.<br />
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<span style="color: red;">Expected Morbidity</span><br />
The expected incidence of sickness or injury within a given group during a given period of time as shown on a morbidity table.<br />
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<span style="color: red;"> Experience Rating</span><br />
The process of setting rates based partially or in whole on previous claims experience and projected required revenues for a future policy year for a specific group or pool of groups.<br />
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<span style="color: red;">Experimental or Investigational Procedures</span><br />
Any health care services, supplies, procedures, therapies, or devices that the health plan determines to be either (1) not proven by scientific evidence to be effective, or (2) not accepted by health care professionals as being effective.<br />
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<span style="color: red;">Explanation of Benefits (EOB)</span><br />
The statement sent to a participant in a health plan listing services, amounts paid by the plan, and total amount owed by the patient.<br />
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<span style="color: red;">Extended Care Facility</span><br />
A facility such as a nursing home which is licensed to provide 24-hour nursing care service in accordance with state and local laws. Three levels of care may be provided-skilled, intermediate, custodial, or any combination.<br />
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<span style="color: red;">Extended Coverage</span><br />
A provision in health policies to allow the insured to receive benefits for specified losses sustained after the termination of coverage, such a maternity expense benefits incurred for a pregnancy in progress at the time of the termination. Sometimes referred to as “continuation of care” or “continuity of care.”<br />
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<span style="color: red;">Extension of Benefits</span><br />
A provision in the insurance policy which allows coverage to continue beyond the expiration date of the policy in the case of insureds who are hospital confined on that date.<br />
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<span style="color: red;">FASB</span><br />
The Financial Accounting Standards Board, which is a nongovernmental group that sets standards for generally accepted accounting principles (GAAP).<br />
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<span style="color: red;">Family and Medical Leave Act (FMLA)</span><br />
A federal law passed in 1993 that requires companies to provide eligible workers with up to 12 weeks of job-protected unpaid leave each year for certain medical and family situations, such as the birth of a child or the care of an aged parent. Employees are eligible to take FMLA leave if they’ve worked for the employer for at least 12 months, have worked for at least 1,250 hours over the previous 12 months, and work at a location where the employer has at least 50 workers within 75 miles.<br />
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<span style="color: red;">Fee-for-Service (FFS)</span><br />
The traditional health insurance reimbursement method in which a set fee (e.g., reasonable and customary or allowable charge) is established for each health care service performed. Services are paid for as rendered.<br />
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<span style="color: red;">Field Underwriting</span><br />
The initial screening of prospective buyers of health insurance, performed by sales personnel “in the field.” May also include quoting of premium rates.<br />
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<span style="color: red;">Fiscal Intermediary</span><br />
A commercial insurer contracted by the Department of Health and Human Services for the purpose of processing and administering Part A Medicare claims. Blue Cross Blue Shield of Mississippi is the Fiscal Intermediary for Medicare Part A claims incurred in Louisiana.<br />
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<span style="color: red;">Flexible Spending Account</span><br />
A spending arrangement that allows employers and employees to use pretax dollars to pay for certain health care or dependent care expenses not otherwise covered by insurance. Health care FSAs can be used to finance health care expenses, including deductibles and copayments.<br />
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<span style="color: red;">Formulary</span><br />
A listing of prescription medications that are preferred for use by the health plan and that will be dispensed through participating pharmacies to covered persons. This list is subject to periodic review and modification by the health plan. A plan that has adopted an “open or voluntary” formulary allows coverage for both formulary and nonformulary medications. A plan that has adopted a “closed, select, or mandatory” formulary limits coverage to those drugs in the formulary.<br />
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<span style="color: red;">Franchise Insurance</span><br />
A plan for covering groups of persons with individual policies having uniform provisions, although they may differ in coinsurance and deductible levels. The individual policies are issued to each person with individual underwriting. Solicitation usually takes place among an employer’s work force with his consent. Premiums are payroll deducted. No employer premium contributions are allowed. LHSIC uses the term “list bill” for this type of plan.<br />
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<span style="color: red;">Gatekeeper Model</span><br />
Under this model a primary care physician (the gatekeeper) is the initial contact for the patient for medical care and for referrals. This is also called a closed access or closed panel. Gatekeepers are typical in HMOs, EPOs, and the in-network portion of a POS.<br />
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<span style="color: red;">Generic Drug</span><br />
A drug which is exactly the same as a brand name drug and which is allowed to be produced after the brand name drug’s patent has expired. It is also called a “generic equivalent.”<br />
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<span style="color: red;">Grievance Procedure</span><br />
A procedure which allows a member of a health plan or a provider of benefits to express complaints and seek remedies.<br />
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<span style="color: red;">Group</span><br />
Coverage of a number of individuals under one contract. The most common “group” is employees of the same employer.<br />
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<span style="color: red;">Group Certificate</span><br />
The document provided to each member of a group plan. It shows the benefits provided under the group contract issued to the employer or association. This is called an “Evidence of Coverage” in HMOs.<br />
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<span style="color: red;">Group Contract</span><br />
A contract of insurance made with an employer or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association, members of a welfare or employee benefit association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.<br />
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<span style="color: red;">Guaranty Fund</span><br />
See Louisiana Life and Health Insurance Guaranty Association (LLHIGA).<br />
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<span style="color: red;">Guaranteed Issue</span><br />
Required issuance of an insurance policy without any medical underwriting. Under group insurance, all group participants are covered regardless of health history. Guaranteed issue is required under HIPAA for groups under 51. There is no guaranteed issuance of individual policies under state or federal law, except for persons losing group coverage. (See “Conversion”)<br />
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<span style="color: red;">Guaranteed Renewability</span><br />
A right to continue a contract of insurance in force by payment of premiums. The insurer has no right to make any change in any provision of the contract except, in the case of group contracts, on the anniversary date of the contract, and except, in the case of individual contracts, changes made to the contracts of all policyholders uniformly.<br />
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<span style="color: red;">HCFA 1500</span><br />
A form developed by HCFA and used by providers of health services to bill their fees to health carriers.<br />
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<span style="color: red;">Health Care Financing Administration (HCFA)</span><br />
Part of the Department of Health and Human Services, responsible for administration of the Medicare and Medicaid programs.<br />
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<span style="color: red;">Health Insurance (HI)</span><br />
Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense. The term Health Insurance is now used to replace such terms as Accident Insurance, Sickness Insurance, Medical Expense Insurance, Accidental Death Insurance, and Dismemberment Insurance. The form is sometimes called Accident and Health, Accident and Sickness, Accident, or Disability Income Insurance. Dental insurance, disability insurance, and accidental death and dismemberment insurance is also considered health insurance.<br />
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<span style="color: red;">Health Insurance Portability and Accountability Act of 1996 (HIPAA)</span><br />
A federal law designed to provide portability of health coverage by limiting what may be considered pre-existing conditions and exclusions for pre-existing conditions in health plans. HIPAA also requires guaranteed issuance of coverage in the small group market, guaranteed issuance of individual coverage upon loss of group coverage, and guaranteed renewability of coverage in the group and individual markets. Under its Administrative Simplification provisions, HIPAA requires use of unique identifiers, standard data sets, and ensures privacy and security of an individual’s identifiable health information.<br />
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<span style="color: red;">HIPAA Pool</span><br />
A legislatively created insurance pool providing coverage to individuals losing group health coverage. Funded by assessments of health insurers. See Louisiana Health Plan and Conversion.<br />
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<span style="color: red;">Health Insurance Purchasing Cooperatives (HIPCS)</span><br />
Purchasing agents for health insurance consumers under a managed-competition system, also called health insurance purchasing groups, health plan purchasing cooperatives, and health insurance purchasing corporations.<br />
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<span style="color: red;">Health Maintenance Organization (HMO)</span><br />
An HMO is a prepaid medical service plan that provides services to plan members either through employed staff or medical providers who contract with the HMO. Members must use contracted providers to receive benefits except in certain circumstances, such as emergencies.<br />
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<span style="color: red;">HealthMarts</span><br />
Collectives of small businesses joined together to purchase health insurance.<br />
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<span style="color: red;">Health Plan Employer Data and Information Set (HEDIS)</span><br />
Standard performance measures collected by the National Committee for Quality Assurance and published in the form of a report card to help employers evaluate plan performance.<br />
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<span style="color: red;">High Risk Pool</span><br />
A legislatively established health plan for uninsurable Louisiana residents. Funded by service charges of $2.00/day for inpatient stays and $1.00 for ambulatory surgical care admissions. Louisiana insurers are required to cover these charges.<br />
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<span style="color: red;">Home Health Care</span><br />
Care received at home as part-time skilled nursing care, speech therapy, physical or occupational therapy, part-time services of home health aides or help from homemakers or choreworkers.<br />
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<span style="color: red;">Hospice</span><br />
An organization which is primarily designed to provide pain relief, symptom management and supportive services for the terminally ill and their families.<br />
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<span style="color: red;">Hospital Income or Indemnity Insurance</span><br />
A form of insurance that provides a stated weekly or monthly payment while the insured is hospitalized, regardless of expenses incurred and regardless of whether or not other insurance is in force. The insured can use the weekly or monthly benefit as he chooses, for hospital or other expenses. LHSIC sells a form of this insurance called the “Variable Income Plan” or “VIP policy,” which pays a per diem.<br />
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<span style="color: red;">In-Area Services</span><br />
Services which are provided within the “authorized” service area as designated in the plan.<br />
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<span style="color: red;">Incurred but Not Reported (IBNR)</span><br />
Costs associated with a medical services that has been provided, but for which a claim has not yet been received by the insurer. IBNR reserves are recorded by the insurer to account for estimated liability, based on studies of prior lags in claim submissions.<br />
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<span style="color: red;">Incurred Claims</span><br />
The actual insurer liability for a special period, including all claims with dates of service within a specified period (usually called the experience period). Given the time lag between dates of service and the dates of claims payments, adjustments must be made to any paid claims data to determine incurred claims.<br />
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<span style="color: red;">Indemnity</span><br />
A health care insurance plan that reimburses policyholders for covered services. There is usually a deductible which must be met before payment starts and a maximum benefit, either annual or lifetime, that the insurer will pay.<br />
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<span style="color: red;">Individual Contract</span><br />
A contract made with an individual that covers that individual and perhaps also specified members of his family for benefits as described in the policy.<br />
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<span style="color: red;">Individual Practice Association (IPA) Model HMO</span><br />
A situation where an individual practice association is contracted with to provide health care services. The individual practice association contracts with individual physicians or groups of physicians for their services.<br />
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<span style="color: red;">Inflation Factor</span><br />
A premium loading to provide for future increases in medical costs and loss payments resulting from inflation.<br />
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<span style="color: red;">In-Force Business</span><br />
Life or Health Insurance for which premiums are being paid or for which premiums have been fully paid. The term refers to the total face amount of a Life insurer’s portfolio of business. In Health Insurance it refers to the total premium volume of an insurer’s portfolio of business.<br />
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<span style="color: red;">Inside Limits</span><br />
Limits placed on benefits which modify benefits from the overall maximums listed in the policy. An inside limit when applied to room and board, limits the benefit to not only a maximum amount payable, but also limits the number of days the benefit will be paid. A prescription drug inside limit limits the benefit to a specific dollar amount in benefits that will be paid in a particular time period.<br />
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<span style="color: red;">Intermediate Care</span><br />
A level of care associated with a skilled nursing facility which provides nursing care under the supervision of physicians or a registered nurse. The care provided is a step down from the degree of care described as skilled nursing care.<br />
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<span style="color: red;">Large Claim Pooling</span><br />
A technique that helps stabilize premium fluctuations. Large claims (those over a stated amount, sometimes called “shock claims”) are charged to a pool contributed to by many small groups. The pooling level depends on the number of groups in the pool.<br />
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<span style="color: red;">Legend Drug</span><br />
A drug which has on its label “caution: federal law prohibits dispensing without a prescription.”<br />
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<span style="color: red;">Length of Stay (LOS)</span><br />
The total number of days a participant stays in a facility such as a hospital.<br />
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<span style="color: red;">Long Term Care (LTC)</span><br />
Care which is provided for persons with chronic diseases or disabilities. The term includes a wide range of health and social services provided under the supervision of medical professionals.<br />
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<span style="color: red;">Long-Term Disability Insurance</span><br />
A group or individual policy which provides coverage for longer than a short term, often until the insured reaches age 65 in the case of illness and for the remainder of his lifetime in the case of accident. See also Short-Term Disability Insurance.<br />
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<span style="color: red;">Loss-Of-Income Benefits</span><br />
Benefits paid for inability to work for remuneration because of disability resulting from accidental bodily injury or sickness. The loss of income may be real or presumptive.<br />
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<span style="color: red;">Louisiana Health Plan</span><br />
A legislatively created plan consisting of the High Risk Pool, the HIPAA Pool, and a non-operating small employer insurance account.<br />
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<span style="color: red;">Louisiana Life and Health Insurance Guaranty Association (LLHIGA)</span><br />
A legislatively created guaranty association created to cover claims of persons whose insurers are significantly financially impaired or insolvent. Does not cover HMOs. Funded by assessments on insurers. See Guaranty Fund.<br />
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<span style="color: red;">Major Medical Insurance</span><br />
A type of Health Insurance that provides benefits up to a high limit for most types of medical expenses incurred, subject to a large deductible. Such contracts may contain limits on specific types of charges, like room and board, and a percentage participation clause sometimes called a coinsurance clause. These policies usually pay covered expenses whether an individual is in or out of the hospital.<br />
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<span style="color: red;">Managed Care</span><br />
A system of health care where the goal is a system that delivers quality, cost effective health care through medical management, the monitoring and recommending of utilization of services, and through contracting for cost of services.<br />
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<span style="color: red;">Managed Care Organization (MCO)</span><br />
Health care plan that emphasizes cost-efficiency in providing care to enrolled members through an organized provider network.<br />
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<span style="color: red;">Managed Health Care Plan</span><br />
A plan which involves financing, managing, and delivery of health care services. Typically, it involves a group of providers who share the financial risk of the plan or who have an incentive to deliver cost effective, but quality, service.<br />
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<span style="color: red;">Mandated Benefits</span><br />
Benefits required by state or federal law.<br />
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<span style="color: red;">Mandated Providers</span><br />
Types of providers of medical care whose services must be included by state or federal law.<br />
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<span style="color: red;">Manual Rates</span><br />
Rates based on average claims data for a large number of groups. These rates are then adjusted for specific groups based on that group’s characteristics, such as the type of industry, changes in benefits from the standard, etc.<br />
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<span style="color: red;">Maximum Allowable Cost (MAC)</span><br />
A pricing of generic drugs developed due to the wide variation of different manufacturer costs for identical generic drugs. The MAC is the highest amount that will be paid for the drug regardless of its actual cost.<br />
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<span style="color: red;">Medical Expense Trend</span><br />
The rate at which medical costs are increasing or decreasing, influenced by, for example, utilization, new technology, and billed charges.<br />
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<span style="color: red;">Medical Loss Ratio (MLR)</span><br />
The cost ratio of health benefits used, compared with revenue received. The MLR is calculated as follows: total medical expenses divided by premium revenue.<br />
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<span style="color: red;">Medical Savings Accounts (MSA) (also called Medical IRAs and Medisave Accounts)</span><br />
A health care financing arrangement that allows regular, pre-tax deposits to personal medical accounts that can be used to pay for medical expenditures or health insurance premiums. These accounts work in conjunction with high deductible health insurance policies.<br />
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<span style="color: red;">Medical Necessity Review Organization (MNRO)</span><br />
An organization of physicians that reviews services to determine if they are medically necessary. Louisiana law was enacted in 1999 regulating MNROs and providing immunity from liability if a licensed MNRO is used to review plan medical necessity determinations.<br />
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<span style="color: red;">Medically Necessary</span><br />
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Services, treatments, procedures, etc., required to identify or treat a member’s illness or injury, that are consistent with the member’s symptoms or diagnosis and treatment and the most appropriate supply or level of care which can safely be provided to the member.<br />
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<span style="color: red;">Medicare Part A</span><br />
The component of Medicare benefits covering inpatient hospital stays, skilled nursing facilities, home health services and hospice care. Medicare Part A is premium-free for anyone automatically eligible for Medicare. Those not automatically eligible may purchase Medicare Part A coverage for a monthly premium.<br />
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<span style="color: red;">Medicare Part B</span><br />
The optional part of Medicare that can be purchased for a monthly premium. Part B covers outpatient costs, such as the cost of physician services, outpatient hospital services, medical equipment, and medical supplies.<br />
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<span style="color: red;">Medicare Supplement Insurance</span><br />
Private insurance coverage sold on an individual or group basis which helps to fill the gaps in the protection provided by the Medicare program. Medicare supplements cannot duplicate any benefits provided by Medicare, but may pay part or all of Medicare’s deductibles and copayments, and may cover some services and expenses not covered by Medicare.<br />
Medicare+Choice (Also known as Medicare Part C)Medicare+Choice is an expansion of Medicare health plan choices created as part of the Balanced Budget Act of 1997 providing an HMO option.<br />
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<span style="color: red;">Medicare Select</span><br />
A type of Medicare supplemental health insurance policy that requires policyholders to use specific hospitals, and in some cases specific doctors, except in an emergency, in order to be eligible for full benefits.<br />
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<span style="color: red;">Member Month</span><br />
The total number of participants who are members for each month.<br />
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<span style="color: red;">Member Touchpoint Measures (MTM)</span><br />
Refers to the methodology being implemented by the Association to define how well the various plans perform in relationship to the brand identification by their market area. This performance is measured by a series of customer surveys and the utilization of specified metrics reported in the NMIS method.<br />
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<span style="color: red;">Minimum Premium</span><br />
A cost plus arrangement whereby the employer pays the insurer only a portion of the premium which is to be used for administration costs. The remainder is placed in a “bank account” which is then used by the insurer to pay claims.<br />
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<span style="color: red;">Morbidity</span><br />
The relative incidence of disease.<br />
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<span style="color: red;">Morbidity Rate </span><br />
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The ratio of the incidence of sickness to the number of well persons in a given group of people over a given period of time. It may be the incidence of the number of new cases in the given time or the total number of cases of a given disease or disorder. </div>
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<span style="color: red;">Morbidity Table </span></div>
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A table showing the incidence of sickness at specified ages in the same fashion that a mortality table shows the incidence of death at specified ages. </div>
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<span style="color: red;">Multiple Employer Trust (MET) </span></div>
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A trust consisting of multiple small employers in the same industry, which is formed for the purpose of purchasing group health insurance or establishing a self-funded plan at a lower cost than would be available to the employers individually. LHSIC uses the term “MET” to describe groups ranging in size from 2-19, even though the trust itself has been dissolved. </div>
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<span style="color: red;">Multiple Employer Welfare Arrangements </span></div>
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Employer funds and trusts providing health care benefits to individuals. </div>
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<span style="color: red;">Multiple Option Plan </span></div>
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Under this plan, employees can optionally choose from an HMO, POS, a PPO or a traditional major medical plan. </div>
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<span style="color: red;">National Committee for Quality Assurance (NCQA)</span></div>
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A nonprofit, Washington, D.C.-based organization, the NCQA is dedicated to assessing, measuring, and reporting on the quality of care provided by the national’s managed care plans. The NCQA manages the evolution of the Health Plan Employer Data and Information Set (HEDIS), a managed care performance measurement tool, issuing accreditation in six categories: quality improvement, physician credentials, members’ rights and responsibilities, preventive health services, utilization management, and medical costs. </div>
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<span style="color: red;">National Drug Code (NDC) </span></div>
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A system for identifying drugs. </div>
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<span style="color: red;">National Management Information System (NMIS)</span></div>
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Refers to the methodology of the various BCBS plans reporting upon defined standardized metrics relating to business functions performed by the plans. These various plan reports are accumulated and reported by the Association in a quarterly format with the metrics used to rank the plans by peer group and as a member of the whole of the Association </div>
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<span style="color: red;">Nonparticipating Provider </span></div>
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(1) A provider who has not signed a contract with a health plan. (2) A medical or health care provider who is not certified to participate in the Medicare program. </div>
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<span style="color: red;">Occupational Disease </span></div>
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Impairment of health caused by continued exposure to conditions inherent in a person’s occupation or a disease caused by an employment or resulting from the nature of an employment. </div>
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<span style="color: red;">Open Access </span></div>
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Allows a participant to see another participating provider of services without a referral. Also called open panel. </div>
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<span style="color: red;">Outcomes Measurement </span></div>
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Assessments that gauge the effect or results of treatment for a particular disease or condition. Outcome measures include the patient’s perception of restoration of function, quality of life, and functional status, as well as objective measures of mortality, morbidity, and health status. </div>
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Outlier</div>
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One who does not fall within the norm. A provider who uses either too many or too few services (for example, anyone whose utilization differs by two standard deviations from the mean on a bell curve is called an outlier.) </div>
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Out-of-Area (OOA)Treatment given to a member outside of his service area. </div>
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<span style="color: red;">Out-of-Pocket Limit </span></div>
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The maximum dollar amount of coinsurance and deductible an individual will be required to pay, after which the insurer will pay 100% of covered expenses up to the policy limit. </div>
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<br /></div>newcamdservershttp://www.blogger.com/profile/11054975238236313257noreply@blogger.com0tag:blogger.com,1999:blog-828977695664493093.post-66573077176705634192012-07-22T07:36:00.000-07:002012-07-22T08:03:21.164-07:00Health insurance: GLOSSARY OF TERMS Part1 A-D<div dir="ltr" style="text-align: left;" trbidi="on">
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Accidental
Death and Dismemberment<o:p></o:p></span></b><br />
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">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.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Accreditation<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">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.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Accrual<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">An accounting
term to describe the practice of recognizing an expense or revenue that has
been realized but has not yet been recorded.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">ACR
(Adjusted Community Rate)<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">The equivalent
of the premium that an HMO organization would have charged to Medicare+Choice
enrollees independently of HCFA payments for Medicare covered services, using
as a basis the same rates it charges to its non-Medicare enrollees and
adjusting for Medicare enrollees’ utilization.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Actively-at-work<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">A provision in
most group health insurance policies 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. Under HIPAA, the employee is eligible to enroll
even though he is not at work, but he may not be eligible for benefits.<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Activities
of Daily Living (ADL)<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">A term usually
used in disability or long term care policies. Everyday living functions and
activities performed by individuals without assistance. These functions would
include mobility, dressing, personal hygiene and eating. <o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Activities
of Daily Living (ADL) Standards <o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">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.<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Actual
Charge<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">The actual
amount charged by a provider for medical services rendered. Sometimes referred
to as “Billed Charge.”<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Acute
Care<o:p></o:p></span></b></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;">Skilled,
medically necessary care provided by medical and nursing personnel in order to
restore a person to good health.<o:p></o:p></span></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: Arial, sans-serif;"><br /></span></div>
<div style="mso-line-height-alt: 3.0pt; text-align: justify;">
<span lang="EN-US"></span></div>
<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Additional
Monthly Benefit <o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">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. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
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<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Accelerated
Life Benefit <o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">Benefits of a
life insurance policy paid in advance of death to an insured in certain
specific circumstances such as contracting cancer or AIDS or suffering a heart
attack or a stroke.<o:p></o:p></span></div>
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<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Adjusted
Average Per Capita Cost (AAPCC)<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">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 and working aged. Used to determine payments to cost
contractors for Medicare benefits. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
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<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Administrative
Expense<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">A company’s
operating costs, fees for medical examinations and inspection reports,
underwriting, printing costs, commissions, advertising, agency expenses,
premium taxes, salaries, rent, etc. Such costs are a component of premium. See
also Retention.<o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
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<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Administrative
Services Only (ASO)<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">A contract
under which a third party will deliver administrative services to an employer
for its health benefits plan. Usually the plan is self-insured (the employer is
at risk for the cost of health care services). Sometimes referred to as
Administrative Service Contracts (ASCs). <o:p></o:p></span></div>
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<b><span lang="EN-US">Admissions/1,000<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">The number of
hospital admissions for each 1,000 members of the health plan. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
<br /></div>
<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Admits<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">The number of
admissions to facilities, including outpatient and inpatient facilities. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
<br /></div>
<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Adverse
Selection<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">A situation in
which a carrier enrolls a poorer risk than the average risk of the group. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
<br /></div>
<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Age
Change<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">The date on
which a person’s age, for insurance purposes, changes. For products that are
rated specific to a person’s age, changes in rates due to age are based on the
age of the person at his last birth date. Rating structures may vary to use age
bands (such as 1, 5 or 10 year age bands) and use age at last birthday, age at
nearer birthday, or age at next birthday in placing persons within age bands.
Generally, rates for individual products are based on a person’s specific age
while rates for group products are based on a compositing of the age for all
members and adjusting rates accordingly. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
<br /></div>
<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Age/Sex
Factor<o:p></o:p></span></b></div>
<div style="font-family: Arial, sans-serif;">
<span lang="EN-US">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. <o:p></o:p></span></div>
<div style="font-family: Arial, sans-serif;">
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<div style="font-family: Arial, sans-serif;">
<b><span lang="EN-US">Aggregate
Indemnity</span></b></div>
<span style="font-family: Arial, sans-serif;"><span lang="EN-US"> <o:p></o:p></span></span><span style="background-color: white;"><span style="font-family: Arial, sans-serif;">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. </span></span><br />
<span style="background-color: white;"><span style="font-family: Arial, sans-serif;"><br /></span></span><br />
<br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Allowable
Charge<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Under Medicare,
this term is 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. Under LHSIC and HMOLA policies, the Allowable Charge is the lesser of
the billed charge or an amount set by the Company as reasonable for the
service. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Alternative
Delivery Systems <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Systems, which
cover health, care costs, other than on the usual fee-for-service basis. Could
include HMOs, IPAs, PPOs, etc. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Alternative
Medicine<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Nontraditional health
care treatments, such as chiropractic services and acupuncture. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Ambulatory
Care <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Care that does
not require hospitalization. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Ambulatory
Setting<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Institutions
such as surgery centers, clinics, or other outpatient facilities which provide
health care on an outpatient basis. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Ancillary
Services<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Additional
services provided by a facility (other than room and board charges) such as
X-rays, anesthesia, lab work, etc. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Approved
Charge<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Amounts paid
under Medicare as the maximum fee for a covered service. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Assignment
<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">An
authorization to pay benefits directly to the provider. Under Medicare,
payments may be assigned to participating providers only. Under LHSIC policies,
assignment of benefits is prohibited. Louisiana law requires honoring
assignments to hospitals; this law may be preempted by federal law (ERISA) for
group plans other than church and governmental plans and for the federal
employees benefit plan (FEP). <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Average
Cost Per Claim <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">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. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Average
Length of Stay (ALOS)</span></b><br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;"> <o:p></o:p></span></b><span style="background-color: white; font-family: Arial, sans-serif;">The average
number of days in a hospital for each admission. The formula for this measure
is a follows: total patient days incurred, divided by the number of admissions
and discharges during the period.</span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Average
Wholesale Price (AWP) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A term usually
applicable to prescription drugs. It is the average of prices charged by
manufacturers for a particular drug. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Balanced
Budget Act of 1997 (BBA)<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Federal
legislation that established Medicare+Choice, which broadens the array of
health plans available to Medicare recipients. This Act established a new
Medicare Part C, allowing Medicare beneficiaries the option of choosing the
Medicare fee-for-service (FFS) program (Parts A and B) or to enroll in
Medicare+Choice plans, effective January 1, 1999. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Bed
Days/1,000 <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The number of
inpatient hospital days per 1,000 members of the health plan. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Benefit
Period <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A period of
time during which benefits may be provided or limited. Usually a calendar year,
but may be shorter for certain benefits (ex. a quarter for prescription drugs).
<o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Birthday
Rule <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Used when
coordinating benefits for a person covered by more than one policy. This method
determines which parent’s medical coverage will be primary for dependent
children: the parent whose birthday falls earliest in the year will be
considered as having the primary plan. See Coordination of Benefits. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Capitation
(CAP) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A rate paid,
usually monthly, to a health care provider. In return, the provider agrees to
deliver the health services agreed upon to any covered person. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Carrier
</span></b><span lang="EN-US" style="font-family: Arial, sans-serif;"><br />
Usually a commercial insurer contracted by the Department of Health and Human
Services to process Medicare Part B claims payments. BCBS Arkansas is the
Medicare Part B carrier for Louisiana. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Carry
Over Provision <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">In major
medical policies, these provisions allow an insured who has submitted no claims
during the year to apply any medical expenses incurred in the last three months
of the year toward the new calendar year’s deductible. Many LHSIC health
policies carry this provision. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Carve-Outs<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Type of service
separately designed and contracted to an exclusive, independent provider. For example,
mental health care, drug and vision coverage are often carve-out services. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Case
Management <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The assessment
of a person’s long term care needs and the appropriate recommendations for
care, monitoring and follow-up as to the extent and quality of services to be
provided.</span><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;"> <o:p></o:p></span><b style="background-color: white;"><span lang="EN-US" style="font-family: Arial, sans-serif;">Case
Manager</span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A person,
usually an experienced professional, who coordinates the services necessary
under the case management approach. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Case
Mix <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The relative
frequency and intensity of hospital admissions or services, which reflects the
different needs and uses of hospital resources. Case mix can be measured based
on patients’ diagnoses or the severity of their illnesses, the utilization of
services, and the characteristics of a hospital. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Case
Rate<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Flat fee paid
for patients’ treatment based on their diagnosis and/or presenting problem. For
this fee, the provider covers all of the services the patient requires for a
specific period of time. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Centers
of Excellence<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">In the
insurance industry, this term refers to a network of health care facilities
selected for specific services and determined to be exemplary based on criteria
such as experience, outcomes, and effectiveness. BCBSA has designated Centers
of Excellence for organ transplant procedures (also known as Blue Quality Centers
for Transplant (BCCT)). <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Certificate
of Authority (COA) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A license
issued by the state Department of Insurance (in Louisiana) to operate an
insurer or HMO (Health Maintenance Organization). <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Chronic
Case Management<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The
coordination of care by a health care professional for an individual whose
illness or condition is characterized by slow progression and/or long
continuance such that care is required on an ongoing basis. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Part of the
Uniformed Services Health Benefits Program which supplements the medical care
available for families of active, deceased, and retired military personnel. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Claims
Adjudication<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The processing
and payment of claims. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Closed
Access <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A benefit
structure under which covered insureds must select a primary care physician.
That physician is the only one allowed to refer the patient to other health
care providers within the plan. Also called Closed Panel or Gatekeeper model. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Coinsurance<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The portion of
the cost for care received for which an individual is financially responsible.
Usually this is determined by a fixed percentage, as in major medical coverage.
Often co-insurance applies after a specific deductible has been met and may be
subject to an individual out-of-pocket limit.</span><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;"><br /></span><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;"> <o:p></o:p></span><b style="background-color: white;"><span lang="EN-US" style="font-family: Arial, sans-serif;">Community
Rating</span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Under this
rating system, the charge for insurance to all insured’s depends on the medical
and hospital costs in the community or area to be covered. Individual
characteristics of the insured’s are not considered at all. Louisiana law
imposes modified community rating for groups under 35 in size and for
individual coverage. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Composite
Rate <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">One rate for
all members of the group regardless of their status as single or members of a
family. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Comprehensive
Major Medical <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A plan of
insurance which has a low deductible, high maximum benefits, and a coinsurance
feature. It is a combination of basic coverage and major medical coverage which
has virtually replaced separate hospital, surgical and medical policies with
each having its own deductible requirements. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Concurrent
Review <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A case
management technique which allows insurers to monitor an insured’s hospital
stay and to know in advance if there are any changes in the expected period of
confinement and the planned release date. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Consolidated
Omnibus Budget Reconciliation Act (COBRA) of 1986 <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Federal
legislation applicable to groups of 20 or more, providing for a continuation of
group health care benefits under the group plan for a period of time when
benefits would otherwise terminate due to loss of employment or eligibility as
a dependent. Coverage may be continued for up to 18, 36, or 54 months,
depending on the circumstances of the loss of coverage. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Continuation
<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Allows
continuation of group health insurance coverage under certain conditions.
Louisiana law provides for continuation for employees losing employment, if not
eligible for COBRA, and for surviving spouses age 55 and over, as well as for
their dependents. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Conversion<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The right to
receive an individual policy after group coverage ends. Once mandatory under
Louisiana law, now persons entitled to conversion are covered under the
Louisiana Health Plan’s “HIPAA” pool. BCBSA requires Blue Plans to issue
conversion policies to persons covered by a sister Blue Plan when they move to
the Blue Plan’s service area. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Coordination
of Benefits (COB) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A policy
provision which helps determine the primary carrier in situations where an
insured is covered by more than one policy. This provision prevents an insured
from receiving more than 100% coverage. Traditionally appears only in group
policies but trend is moving toward allowing COB between group and individual
policies. See also Birthday Rule. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Copayment<o:p></o:p></span></b><br />
<br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">This is a cost
sharing arrangement where the covered person pays a specified amount for
various services and the health care provider pays the remainder. The covered
person usually must pay his or her share when the service is rendered. Similar
to coinsurance, except that coinsurance is usually a percentage of certain charges
where the co-payment is a dollar amount. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Cost
of Living Benefit <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">An optional
disability benefit where the monthly benefit will be increased annually once
the insured is on claim for 12 months. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Covered
Expenses <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Health care
expenses incurred by an insured or covered person that qualifies for
reimbursement under the terms of a policy. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Covered
Person <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A person for
whom premiums are paid and who also meets eligibility requirements. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Credentialing
<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The process of
approving a provider, based on certain criteria, to provide health care
services or participate in a health plan. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Current
Procedural Terminology (CPT) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">This
terminology includes medical services and procedures performed by physicians
and other providers of health care. The health care industry uses it as a
standard for describing services and procedures. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Custodial
Care <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Care that is
primarily for meeting personal needs such as help in bathing, dressing, eating
or taking medicine. It can be provided by someone without professional medical
skills or training but must be according to doctor’s orders. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Date
of Service <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">For
professional claims, the date of service is the date that the health service
was provided. For hospital claims, this is the date of admission. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Death
Spiral <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The potentially
destructive cycle that occurs when the health status of a pool of insured lives
declines as a result of: (1) HMO’s penetrating an indemnity plan, pulling off
healthier employees and causing the indemnity plan’s costs to significantly
increase as measured on a per member basis; (2) The discontinued enrollment of
new, healthy members into a block of business; or (3) The election of healthier
small group members of an association to seek coverage elsewhere (outside the
association) by shopping rates. Since rates are established based on the pool
of individuals covered and the health status of those individuals significantly
deteriorates, the rates for the pool will increase, causing the selection to
continue to occur. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Deductible<o:p></o:p></span></b><br />
<br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">The amount a
policyholder must pay for health care, as established under the terms of his or
her contract, before insurance benefits begin. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Dependent
Coverage <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Insurance
coverage on the head of a family that is extended to his or her dependents,
including only the lawful spouse and unmarried children who are full time
students or are mentally or physically impaired and incapable of self support.
“Children” may be step, foster, and adopted, as well as natural and, under the
Louisiana law, grandchildren who are in the legal custody of, and residing
with, the grandparent. The age limit in Louisiana is 24, but coverage is not
limited by age if the child is impaired and incapable of self-support. LHSIC
policies extend the age limit to 25. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Diagnosis
Related Groups (DRGs) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Set reimbursement
for a hospital stay based on a given diagnosis, regardless of the length of
stay or the level of services provided. Adjustments may be made for
inordinately short or long stays as compared to the norm. Used by Medicare as
well as other insurers. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Disability
Income Insurance <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A form of
health insurance that provides periodic payments to replace income, actually or
presumptively lost, when the insured is unable to work as a result of sickness
or injury. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Discharge
Planning <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Determining
what the patient’s medical needs will be after discharge from a hospital or
other inpatient treatment. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Disease
Management<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A comprehensive
integrated approach to care designed to influence the progression of disease
within select patient populations. In disease management, the emphasis is on
prevention, proactive case management, patient education, and population-based
interventions. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Dread
(or Specified) Disease Policy <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Coverage for
medical expenses arising out of diseases named in the contract. LHSIC offers a
Cancer and Serious Disease (CSD) policy offering three benefit options, which
covers cancer, poliomyelitis, leukemia, diphtheria, tetanus, spinal meningitis,
encephalitis, rabies, and sickle cell anemia. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Drug
Utilization Review (DUR) <o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">A method for
evaluating or reviewing the use of drugs in order to determine the
appropriateness of the drug therapy. <o:p></o:p></span><br />
<br />
<b><span lang="EN-US" style="font-family: Arial, sans-serif;">Durable
Medical Equipment (DME)<o:p></o:p></span></b><br />
<span lang="EN-US" style="font-family: Arial, sans-serif;">Reusable
medical equipment, such as hospital beds and wheelchairs, which can be used by
patients either in a hospital or a home setting. <o:p></o:p></span><br />
<br />
<br />
<br />
<br /></div>newcamdservershttp://www.blogger.com/profile/11054975238236313257noreply@blogger.com0