GlossaryHealth InsuranceA to B
You will find an expanded list and definition of terms in this glossary health insurance A to B section.
Use it often, especially when you begin to review your health insurance options and benefits.
A
accidental death and dismemberment (AD&D) rider: Provides additional cash benefit (paid either in lump sum or weekly amount over a specified period) to you and your beneficiaries in case of an accident. This can be sold as a policy or included as a provision of a policy.
acute care: Highly skilled and medically professional care given to a patient to restore functional health.
adverse selection: The tendency for people requiring more medical attention to more likely sign up for insurance. This results in a health insurance pool containing a disproportionate share of people with medical conditions, and leads to higher premiums that drive healthier people out of the pool.
ambulatory care: Medical services provided on an outpatient (non-hospitalized) basis. Services may include diagnosis, treatment, surgery and rehabilitation.
ancillary services: Health care services conducted by providers other than physicians and surgeons. These include such services as physical therapy and home health care.
assignment of benefits: Your signed authorization to your medical service provider (your doctor or hospital) assigning payment to be made directly to them for medical treatment.
accreditation status: The National Committee for Quality Assurance (NCQA) grants health plans three classes of accreditation - Full, One-Year, and Provisional, based on a variety of quality standards.
assisted living facility: A residential community for senior citizens that provides nursing care.
B
balance billing: The practice when medical care providers (such as
doctors, hospitals or other medical practitioners) bill you for the portion of
the bill not paid by your insurance company. The practice is prohibited by
Medicare and some managed care companies.
basic medical insurance: Insurance covering the typical hospital, surgical, and physician expenses including hospital room and board, cost of x-rays, anesthesia, operating room, additional lab charges, surgeon fees, and routine doctor visits
benefit: Amount payable by the insurance company to you, your assignee or
beneficiary when the you suffer a loss.
benefit period: The interval in which you are able to receive benefits. Typically, the benefit period begins with the first medical service received for an illness and ends after you have not been hospitalized due to the condition for 60 consecutive days.
beneficiary: You and your dependents who are entitled to receive benefits under a plan.
broker: A sales agent who sells insurance products of more than one insurance company.
business day: Every day that insurance companies are open for business, excluding Saturday, Sunday, and state and federal holidays.
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