Health Insurance Glossary
We want you to know the ins-and-outs of health insurance. That's why we've built this glossary of terms because we know that although the words are English, they often have different meanings than what we know them to be. You can check for a specific term that you are curious about or read the entire glossary if you are prepared for the most fun-filled day you have ever had. Enjoy.A-C D-F G-K L-N O-Q R-T U-Z
A Gatekeeper is another name for the primary care physician. This person is responsible for supervising and overseeing all components of a patient's medical care.
A Generic Drug is a substitute prescription drug manufactured by a pharmaceutical company that is typically a less expensive version. These drugs are exactly the same as a brand name drugs, but they are produced by a different company after the brand name's drug patient has expired.
The Geographic Availability is the number of health care providers available within a given geographic are or to a given group on members.
The Grace Period is a set number of days after an insured's premium coverage is due that it may not be canceled until a premium payment is received.
A Grievance Procedure is a process that allows a health plan member to voice their concerns and complaints to their health insurance provider.
A Group refers to the individuals medically covered under a group health insurance policy. The group members are typically the employees.
Group Health Insurance
Group Health Insurance is a type of health insurance offered to employees through an organization or an employer.
A Guaranteed Issue Plan is a term used to describe the requirement that a health insurance provider will accept everyone, regardless of age, income or health if they are approved and pay their premium.
Health Care Financing Administration (HCFA)
The Health Care Financing Administration (HCFA) is a federal agency within the Department of Health and Human Services that is responsible for the administration of the Medicare and Medicaid programs.
Health Care Quality Improvement Act (HCQIA)
The Health Care Quality Improvement Act (HCQIA) of 1986 was passed by congress to protect hospitals and other health care providers who are participating in a medical peer review committees from potential liability after the revocation of a physicians hospital privileges. This act has been vital in establishing a benchmark for peer review. Since the Health Care Quality Improvement Act has been pass the National Practitioner Data Bank system has been created to report physicians whose competency has come under scrutiny.
Health Information Network (HIN)
A Health Information Network (HIN) is a on-line computer network that provides a secure way to connect health care providers, insureds, and other health care professionals. This could potentially improve the coordination of care between hospitals, health care providers, medical labs and many more health care facilities. The Health Information Network also stands to lower health care costs by reducing medical errors, incomplete patient information and paper files.
Health Insurance Portability and Accountability Act (HIPAA)
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rule protects the privacy of individual's health information and maintains their confidentiality for patient safety. This standard of healthcare is meant to increase the efficiency and effectiveness of the healthcare system. Title 1 of the Health Insurance Portability and Accountability Act regulates group health insurance plans and individual health insurance plans. It can limit the restrictions that a group health insurance plan can place on its insured in regards to pre-existing conditions. It also prohibits the discrimination against employees and dependents based on their health status. Some health insurance plans may be exempt and the requirements of Title 1 and must be reviewed. Title 1 of the Health Insurance Portability and Accountability Act also protects employees when they change or lose their job by giving employees the right to buy individual health insurance when you have exhausted COBRA (Consolidated Omnibus Budget Reconciliation Act) benefits or do not have access to a group health insurance plan.
Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a health service that offers prepaid medical coverage for a wide range of medical services. HMO's are typically used for physician and hospital medical care not emergencies.
Health Reimbursement Account (HRA)
A Health Reimbursement Account (HRA) is funded solely by the employer and may not be funded by employee salary reduction or deferrals. These employers established benefit plans can offer several benefits to the employee. The contributions made to the Health Reimbursement Account (HRA) can be excluded from the employeeâ€™s gross income, therefore reducing their tax burden. Reimbursements or distributions from the Health Reimbursement Account (HRA) may be tax free if they are to used pay for qualified medical expenses and described by the IRS Publication 502, Medical and Dental Expenses. Qualified medical expenses include amounts used to pay for health insurance premiums, amounts that are not covered under the health care plan and insurance premiums for long-term care coverage. Unused funds in the Health Reimbursement Account (HRA) can be carried forward for further reimbursement in the coming years. There is no limit on the amount that the employer may contribute on behalf of the employee. If an individual is no longer eligible for a Health Reimbursement Account (HRA), the distribution amount will added to your income and is also subject to a 10% additional tax.
Health Risk Assessment
Health Risk Assessment is a statistical process in which a health insurance plan uses information about it's insureds medical history and habits to determine the probability of illness or injury.
Health Savings Account (HSA)
A Health Savings Account (HSA) is a tax-free medical savings account that allows individuals to save for future medical expenses and pay for current medical fees.
Health Services Agreement
A Health Services Agreement is a detailed agreement between a health insurance provider and an employer explaining all insurance benefits, standards, rules for eligibility and procedures.
High Deductible Health Plan (HDHP)
A High Deductible Health Plan (HDHP) has a higher than average annual deductible and a maximum limit on annual allowable out-of-pocket expenses. These expenses include deductible or co-payment amounts but not premiums. Some High Deductible Health Plans (HDHP) may also provide preventive care without deductible. These plans may also be referred to as catastrophic healthcare plans. HDHP's are often used in conjunction with Health Savings Accounts (HSA's). Per the IRS guidelines in order to receive taxable benefits via an HSA it must be used with an underlying HDHP.
Home Health Agency
A Home Health Agency is an organization that offers medical, therapeutic and other medical services to patients in their homes.
Home Health Care
Home Health Care is a service performed in a patient's home for a range of medical and non-medical duties. Those services may include nursing care, cleaning, meal preparation or therapy.
Hospice Care refers to a specialized set of medical services performed by a team of medical professionals for terminally-ill patients and their families. These services may include grief counseling, legal help, physical therapy or spiritual care.
A Hospitalist is a physician or healthcare provider that cares for you while you are in the hospital and communicates with your primary care physician. Hospitalists are more familiar with the hospitals and their systems and procedures. These providers may also be able to spend more time with the patients as they are not trying to squeeze in hospital rounds on their lunch hour like many primary care or specialist physicians. Hospitalists may be Internal Medicine Specialists, Primary Care Physicians or Pediatricians. Hospitalists are also sometimes hired by traditional office practicing physicians to handle their on-call hours.
Immunizations programs are preventative care programs to offer vaccines to help protect children and adults for disease or illness. There are many Immunization Programs available to help those who cannot afford to vaccinate or immunize their children or themselves. Some of these programs are available through the Center of Disease Control and Preventions (CDC).
In-Area Services are medical services provided in authorized locations covered within a health insurance plan.
An Incontestable Clause is an insurance policy provision that states that an insurer cannot contest a medical application after the health insurance poicy has been in force for a limited amount of time (usually two years). After that time, the contract will remain in force and the insurer cannot deny or reduce benefits that were in effect before the coverage date.
An Indemnity Plan, also called a "Fee-For-Service" Plan, occurs when an insurer pays part or all of authorized medical services that an insured selects from a health insurance provider.
Independent Practice Association (IPA)
An Independent Practice Association (IPA) is a legally organized group of physicians or healthcare providers that contract with health insurance plans to provide healthcare services to the members. In an Independent Practice Association (IPA), typically the providers to share the economic risks but not the overhead.
Individual and Family Health Insurance
An Individual and Family Health Insurance plan is health insurance coverage purchased by an individual (and their dependent's), not by a group health insurance plan.
The Individual Market is the group of individuals who are not eligible for Medicare, Medicaid, or group health insurance who qualify for individual health insurance.
Infertility is the biological inability for an individual to conceive a child or contribute to the conception process.
An Inpatient is an individual who receives medical care in a hospital for at least 24 hours.
Integrated Delivery System
An Integrated Delivery System (IDS) is a provider organization comprised of medical professionals and hospitals who collaborate for a variety of medical services and treatments for the benefit of patients.