Glossary (Part 2) - May 10, 2010
Liability: An obligation reflecting legal indebtedness or possible financial exposures.
Liability Coverage: Protects consumers from financial obligations to cover physical injury or property damages that occur in an accident. Most insurance quotes include bodily injury and property damage clauses.
Long-Term Care Policy: health Insurance coverage that specifies designated services for an exact period of time. Long-term care Health Insurance programs and fee structures vary significantly. Some LTC insurance programs cover medical services such as: nursing home stays, in-home health care service, and long term custodial healthcare.
LOS: length of stay health insurance coverage is used by insurance companies and employers to establish the designated length of stay an individual can claim for a hospital or in-patient treatment facility.
Managed Care: A medical service system designed to better manage the cost and quality of medical services that insurance policy holders receive. Many managed care health insurance programs work with HMO and PPO boards to promote use of specific health treatment procedures. Managed care health insurance plans also educate and work with consumers to improve overall health by addressing disease prevention.
Maximum Dollar Limit: The cap or highest amount of money that a health insurance company will pay for claims processed in a specific time period. These could be based on or described in terms of type of medical condition or service treatment. Many times lifetime specifications are used rather than yearly limits.
Medigap Insurance Policies: health insurance offered by a private medical insurance company, not the state or federal government. This does not represent Medicaid or Medicare. These medical insurance plans are developed to cover some of the medical costs that Medicaid and Medicare do not recognize.
Medical Payments Coverage: This insurance coverage covers hospital or medical treatment bills and sometimes funeral expenses if a primary operator or passengers are critically injured or killed in an insured passenger vehicle.
No-Fault Insurance: Type of auto insurance coverage establishing how an insurance company will settle a claim covered by their policy. Many times responsibility does not need to be assigned prior to an insurance claim being settled.
No-Fault States: States that require insurance companies to cover a policyholder’s financial losses, regardless of who has been determined legally responsible for an accident. Many no-fault states also prohibit the right to legally pursue damage claims. In states that do not recognize no-fault obligations, insurance companies are obligated to cover financial losses that occur as a result of an accident involving a policyholder.
Open-ended HMOs: HMO programs that allow enrolled participants to use out-of-plan medical professionals and still redeem partial or full payment for the health care services provided in a standard indemnity health insurance plan.
Out-Of-Plan: refers to doctors, hospitals, and other medical treatment service providers who are not actually participants in a health insurance program (such as an HMO or PPO). Costs depend on the health insurance plan and type of health services performed by any out-of-plan medical professionals that are not covered, or only partly covered by the group health insurance company.
Out-Of-Pocket Maximum: fixed sum of money that any single insured person must pay using their own money or funds, prior to a national health insurance company covering a consumers’ health care bills in full.
Outpatient: Any person that undergoes health care or medical treatment on an outpatient basis that does not mandate an overnight hospital stay. Many major health insurance companies publish lists of specific medical treatments, tests, and services that are not recognized unless they are performed on an outpatient basis. This term can also pertain to ambulatory care or to list specific medical treatment facilities that offer specialty surgeries.
Policy Expiration Date: The calendar date that an insurance policy ends if it is not renewed. This validation end date is usually listed on the declarations page of an insurance policy, and is referred to often on insurance renewal notice documents.
Policy Term: Specific length of time an insurance policy is valid.
Pre-Admission Certification: can also be names pre-certification review, that means a medical case manager or certified health insurance associate must request admittance to a medical treatment facility, before being physically admitted to the facility. The health insurance policyholder usually assembles pre-admission certification documents. Physicians, Surgeons, or nurses may contact the patient. This avoids patients from early exposure to unnecessary health care treatment services.
Pre-Admission Review: A review of a patient’s health status or physical condition, before admission is granted to an inpatient medical facility or hospital. Pre-admission reviews administered by health insurance representatives in cooperation with the doctor, HMO, PPO or health insurance provider.
Preadmission Testing: Medical tests conducted prior to hospital or health care facility admission.
Pre-existing Conditions: medical conditions outside of health insurance coverage as the condition or ailment existed before the health insurance policy was granted.
Preferred Provider Organizations (PPOs): a group that offers discount health insurance rates that offer doctors from a pre-determined list of professional care givers. If a doctor not included in the PPO plan is selected, the health insurance policyholder must cover the all fees for the medical treatment.
Primary Care Provider (PCP): A doctor responsible for administering a health insurance consumer’s health care needs. PCP is usually the medical care gatekeeper, sending the patient too more specialized physicians for specialist care.
Primary Driver: The consumer that operates the insured vehicle most often.
Primary Policyholder: The consumer designated to function as the primary contact person with the insurance company. The insurance policy usually lists the name of this consumer who is essentially responsible for any premiums associated with the coverage.
Property Damage Liability Coverage: Protects car insurance or auto insurance policyholders from financial requirements related to property damage that occurs as a result of a car accident. Property damage insurance premiums help covers the costs of damaged property and also helps pay some legal expenses incurred from lawsuits that result. Property Damage policy clauses usually include a cap or ceiling limit established upon acceptance of the car insurance coverage or auto insurance policy.
Provider: health care professionals who perform specific professional medical services. Many times this refers specifically to physicians. Sometimes this also relates health care professionals such as treatment centers, nurses, physical therapists, and other specialized doctors.
Reasonable and Customary Fees: fees set forth by health care providers within a designated state or geographic market area. These phrases are often used by medical plans as the set amount of money that approves a specific medical test or surgical procedure. If the medical fees are greater than the pre-approved amount, the individual receiving the service is responsible for paying the difference. Sometimes, however, if an individual questions his doctor concerning the fees, some professionals will lessen the amount that any insurance company has listed as customary.
Rental Car Reimbursement: An optional item found in many car insurance or auto insurance policy programs that assists in covering rental car payments if the insured vehicle is lost, stolen, damaged, or not operating as a result of an accident.
Risk: The probability percentage of loss or the amount of possible loss to the holding medical insurance company. Risk represents probabilities including the: likelihood of complicated surgery, prescription drug side effects, chance of infection, or the length of suffering caused by a lifestyle choice. Consumers increase their risk of obtaining cancer if they partake in smoking tobacco.
Second Opinion: an additional review by another doctor or surgeon, when a first surgeon registers a diagnosis or suggests a type of surgery to any individual health care consumer. Patients are encouraged to obtain a second opinion when a doctor urges complicated or difficult surgical procedures to patients with a serious medical problem.
Second Surgical Opinion: assumed health care benefits in most group health insurance plans. An opinion detailed by second surgeon, when the first opinion encourages surgery to a health services consumer.
Secondary Driver: An additional vehicle operator listed on a car insurance or auto insurance policy insured to operate the vehicle covered in the policy in addition to the primary operator.
Short-Term Disability: injury or sickness that prevents a consumer from attending work for a brief period of time. The definition of short-term disability usually varies by Health Insurance Company and corporate employers. Short-term disability insurance coverage is offered to ensure a health care consumer receives full employment wages during a leave of absence required from a physical injury or medical illness that prevents a health care consumer from attending work on a regular basis.
Towing Coverage: An optional item included in many car insurance or auto insurance policies, that provides monetary benefits to cover towing of a vehicle that stops operating as a result of an accident.
Triple-Option: a medical Insurance policy that provides three separate options that an individual is allowed to choose from. Often times, these three choices can include: a Health Maintenance organization – HMO, Preferred Provider Organization – PPO, or indemnity.
Usual, Customary and Reasonable (UCR) or Covered Expenses: A fixed cost incurred for medical services and treatment supplies that are deemed necessary, preferred by a doctor, or provided in treatment.
Variable Annuity: Provides insurance consumers the option of investing in multiple financial programs that function similar to mutual funds in a portfolio manner that includes tax deferred earning capabilities. Variable annuities present both risks and rewards superior to Fixed Annuity insurance programs and are subject to market fluctuations.
VIN: Stands for Vehicle Identification Number, a number used to identify every passenger vehicle. This number is similar to a serial number, that outlines specifics of every vehicle usually the production year, manufacturer, and model name. These VIN number needs to be listed on an auto insurance or car insurance policy agreement forms.
Waiting Period: A period of time when a health insurance policyholder is not covered by a medical insurance policy for a specific health services treatment.
Source: NebraskaInsurannceZone.com
