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
The Rating Process is the process of determining premium rates for health insurance policies. This process takes into consideration factors such as age, sex, job, etc.
Reasonable and Customary Charges
The Reasonable and Customary Charges are the average fees charged by a healthcare provider for a medical services rendered in a particular area.
A Referral is an authorized permission by a healthcare provider or healthcare physician to allow a patient to receive specialized medical care from a medical specialist.
A Renewal is a continuance of healthcare coverage beyond its original policy terms plan.
The Renewal Date is the specific date that a health insurance policy become official.
Respite Care is a medical benefit to members of a family who normally care for a patient. This benefit allows those primary caretakers a break from caring for the patient.
A Rider is a legal document that modifies a health insurance policy. These changes may include the addition or expansion of medical services.
Schedule C is a federal tax form that is used to report any loss or profit from a business. Health insurance companies ask for this form from businesses for group health insurance plans.
A Schedule K-1 is a federal tax form used to report a beneficary's or business partners share of profit, credits and decuctions from specific trusts or partnerships. This form is typically required by health insurance companies for group health insurance.
Screening Programs are preventive programs designed to test for possible illness or disease when no symptoms are present. Some examples include breast examinations, prostate screening, cervical cancer screening and colon cancer screening.
Second Surgical Opinion
A Second Surgical Opinion is an opinion provided by a second physician to determine whether a surgical procedure is necessary.
Secondary Care is a medical service provided by a physician who is not typically a primary care physician. This care is provided by a medical specialist such as a cardiologist or dermatologist.
Secondary Coverage is coverage that provides payment for medical fees not covered by a primary health insurance plan.
Self-Funded Health Insurance Policy
A Self-Funded Health Insurance Policy is a health plan that is funded by an employer or other type of group health provider.
The Service Area is an area where a health insurance plan is accepted from members.
Standard of Care
The Standard of Care is the diagnostic and treatment process that a provider should follow for a specific illness or clinical circumstance.
State Children's Health Insurance Program (SCHIP)
The State Children's Health Insurance Program (SCHIP) provides health insurance coverage to children under the age of 18 from low income families who cannot afford health insurance. Each state operates under its own name and eligibility may vary based on state. These children may also be eligible for Medicaid benefits. For more information on the State Children's Health Insurance Program you may call 1-877-KIDS-Now for more details.
Temporary Partial Disability
Temporary Partial Disability is a condition where a person is injured for a period of time but is able to work at a reduced capacity.
Temporary Total Disability
Temporary Total Disability is a medical condition where a person is prevented from working while recovering from an injury.
A Terminally Ill refers to the status of an extremely ill person likely to die within 6 months.
Tertiary Care is highly specialized medical care for patients who are in danger of death or disability.
Third Party Administrator (TPA)
A Third Party Administrator (TPA) is an organization that processes claims on behalf of health insurance company or self funded health plan but does not have financial responsibility in paying the benefits. Third Party Administrators (TPA) may also manage provider networks, utilization review, membership activities and flexible savings accounts.
Three-Tier Copayment Structure
A Three-Tier Copayment Structure is a prescription drug benefit copayment system under which a member pays one level of copayment for generic drugs, a higher copayment amount for brand-name drugs and an even higher copayment amount for a non-formulary drug.
A Treatment Facility is a residential or non-residential medical care facility authorized to provide treatment for the treatment of a mental health or substance abuse condition.
Triage is a process by which patients are classified according to their medical condition. Treatment is then given to them sort by urgency.
Two-Tier Copayment Structure
A Two-Tier Copayment Structure is a prescription drug benefit copayment system under which a member pays one copayment for generic drugs and a higher copayment for brand-name drugs.