Health Insurance Glossary

This is a list of health insurance related terms and definitions. Test your knowledge with a game of health insurance glossary hangman. If you think it's missing any important terminology, please let me know. Thanks for your visit. Enjoy!

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Health Insurance Terms Hangman

Terms Continued

Fee-for-Service
A payment system for health care where the provider is paid for each service rendered rather than a pre-negotiated amount for each patient.
Fee Schedule
A complete listing of fees used by health plans to pay doctors or other providers.
First Dollar Coverage
Refers to not having to meet a calendar year deductible prior to receiving reimbursement or payment for a medical service.
Flexible Benefit Plan
A benefits package allowing an employee to choose from a range of benefit choices.
Flexible Spending Account
An employee benefits cash account from which non-taxable withdraws can be made to fund eligible expenses defined by the employer-sponsored plan. The FSA is funded by reductions in salary prior to calculation of federal income and social security taxes.
FSA
An acronym for Flexible Spending Account.
Formulary
A list of certain drugs and their proper dosages. Under most health plans, better benefits are provided for formulary drugs than are provided for non-formulary drugs.
Free-Look Period
Typically a 10-day period during which a newly insured person can cancel a policy and receive a full refund of paid premium.
Full-Time Student
Under a health plan, an eligible dependent child student (typically age 19 or older) who meets the health plan's criteria of full-time. Such criteria normally typically includes minimum credit hour requirements (such as 12 credit hours in a semester) and a maximum age (age 23 is typical).
Gag Rule Laws
Special laws that make sure that health plans let doctors tell their patients complete health care information. This includes information about treatments not covered by the health plan.
Gatekeeper
A primary care physician in a managed care environment who is responsible for managing the patient's overall care and who must authorize all specialist referrals. In most health maintenance organizations, the secondary care is not covered by insurance if the primary care physician does not approve it.
General Agent
This typically refers to a middle man agent who facilitates business between retail agents and the insurance company.
Grievance
Request made to a health plan to reconsider coverage of a health care service that the health plan has not interpreted to be a covered benefit.
Group Health Plan
A health plan that provides health coverage to employees and their families, and is supported by an employer or employee organization.
Guaranteed Issue
Under guarantee issue, a health insurance company or HMO must issue coverage to an applicant regardless of prior medical history.
HCFA Common Procedure Coding System
Name given to CPT codes (Level I), alphanumeric codes (Level II), and local codes (Level III) used by payers and providers for billing purposes. Within the industry, most refer to Level II national codes as HCPCS codes.
HCPCS
An acronym for HCFA Common Procedure Coding System.
Health Care Provider
A doctor, hospital, laboratory, nurse, or anyone who delivers medical or health-related care.
Health Employer Data and Information Set
A set of standard performance measures that provides information about the quality of a health plan. These measures are used to compare managed care plans.
HEDIS
An acronym for Health Employer Data and Information Set.
Health Insurance Portability and Accountability Act
A law passed in 1996, which is also called the Kassebaum-Kennedy law. This law expanded health care coverage for persons who have lost their job, or move from one job to another. HIPAA protects persons who have pre-existing medical conditions, and/or problems, based on past or present health, in getting health insurance coverage.
HIPAA
An acronym for Health Insurance Portability and Accountability Act.
Health Maintenance Organization
Prepaid health plans which cover doctors' visits, hospital stays, emergency care, surgery, preventive care, checkups, lab tests, X-rays, and therapy. In a HMO, one must choose a primary care physician who coordinates all care and makes referrals to any specialists that may be required. In a HMO, one must use the doctors, hospitals and clinics that participate in your plan's network. No benefits are paid for non-emergency benefits provided outside the HMO network.
HMO
An acronym for Health Maintenance Organization.
Health Reimbursement Arrangement
A tax-advantaged employee health spending account funded and owned by the employer. Funds remaining in the account at year-end revert to the employer. For the employee, HRAs are a use it or lose it proposition.
HRA
An acronym for Health Reimbursement Arrangement.
Health Savings Account
Operating similarly to IRAs, HSAs are tax-advantaged savings accounts for health care services. A person must enroll in a qualified High-Deductible Health Plan (HDHP) before they can establish an HSA.
HSA
An acronym for Health Savings Account.
High Deductible Health Plan
A person must be enrolled in a qualified High-Deductible Health Plan before they can establish a Health Savings Account. Not all high-deductible health plans qualify for purposes of establishing HSA eligibility. A qualified HDHP benefit design must conform to various federally-mandated requirements, such as a minimum $1000 deductible and a lack of first-dollar benefit provisions.
HDHP
An acronym for High Deductible Health Plan.
Home Health Care
Services given at home to aged, disabled, sick, or convalescent individuals not needing institutional care. The most common types of home care are visiting nurse services and speech, physical, occupational, and rehabilitation therapy. These services are provided by home health agencies, hospitals, or other community organizations.
Hospice Care
Care for the terminally ill and their families, in the home or a non-hospital setting, that emphasizes alleviating pain rather than a medical cure.
Hospital Care
Reimbursement for both inpatient and outpatient medical care expenses incurred in a hospital. Inpatient Benefits include; Charges for room and board, charges for necessary services and supplies sometimes referred to as hospital extras, other hospital extras, miscellaneous charges, and ancillary charges. Outpatient Benefits include; surgical procedures, rehabilitation therapy, and physical therapy.
Hospital-Surgical Coverage
A form of health insurance that offers coverage of certain costs related to hospitalization and surgical procedures. A hospital-surgical plan does not cover other types of medical services, such as physician office visits and outpatient prescription drugs.
Impaired Risk
An insurance applicant who has pre-existing poor health or is in substandard physical condition, is engaged in dangerous activities, or has a hazardous occupation.
Incurral Date
The date on which health care services are provided to a covered person. The incurral date, not the date on which the insurance company pays a health care claim, is the critical date in determining health insurance benefits. For example, a health insurance company will not pay a claim for health care services incurred prior to the effective date of the health insurance coverage.
Indemnity Health Plan
Indemnity health insurance plans are also called fee-for-service. These are the types of plans that primarily existed before the rise of HMOs and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the health plan pays the other percentage. For example, an individual might pay 20% for services and the insurance company pays 80%. The fees for services are defined by the health care providers and vary from physician to physician and hospital to hospital.
Independent Practice Associations
A type of HMO in which care is provided by independent physicians who contract with the HMO. This contrasts with the staff model HMO, in physicians are employees of the HMO.
IPA
An acronym for Independent Practice Associations.
Inpatient Care
Health care that you get when you stay overnight in a hospital.
Insured
A person who has obtained health insurance coverage under a health insurance plan.
International Classification of Diseases, 9th Revision, Clinical Modification
Coding system maintained by the National Center for Health Statistics and the Center for Medicare and Medicaid Services. This coding system differentiates diagnostic conditions and is used by hospitals, governments, health insurance plans, and health care providers around the world.
ICD-9-CM
An acronym for International Classification of Diseases, 9th Revision, Clinical Modification.

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