Explore health plans for your family, including short-term gap coverage and more. While these terms can be confusing, the better you understand them, the better you will be prepared to successfully gain coverage and access to the treatments that are right for you. Depending on your plan, your coinsurance usually kicks in after you meet your deductible. Aetna. Kidnap/Ransom Insurance - coverage for ransom or extortion costs and related expenses. The Cigna names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of The Cigna Group. Health insurance is a contract between a company and a consumer. Common Health Insurance Terms and Definitions | WPS Examples of items covered are pension plans, group life insurance, group health insurance, group disability income insurance, and accidental death and dismemberment. Arbitration - a binding dispute resolution tactic whereby a conciliator with no interest in the outcome intercedes. When I had to change plans, I felt like I was reading Greek! This annuity contract provides for the initiation of payments at some designated future date. Consumer Glossary - National Association of Insurance Commissioners Affiliate - a person or entity that directly, or indirectly, through one or more other persons or entities, controls, is controlled by or is under common control with the insurer. Basic care payout level . Health Reimbursement Arrangement (HRA) Health Savings Account (HSA) Health status. Foreign Investment - an investment in a foreign jurisdiction, or an investment in a person, real estate or asset domiciled in a foreign jurisdiction. Demutualization - conversion of a mutual insurance company to a capital stock company. An Exclusive Provider Organization (EPO) is a type of insurance plan with fewer providers to choose from. Generally provides a stated dollar amount per annual eye examination. Surplus - insurance term referring to retained earnings. If the coverage is as a rider, deductibles or out-of-pocket limits must be set separately from the medical coverage. Access technology tools and resources for U.S. insurance regulators. Your doctor may suggest that you participate in a clinical trial as a treatment option. 1991-2023 National Association of Insurance Commissioners. For plans with a deductible, the coinsurance is the percent you, as the patient, are required to pay for a medical service after youve met your deductible. Cost. three essential characteristics: a) It embodies a present duty or responsibility to one or more other entities that entails settlement by probable future transfer or use of assets at a specified or determinable date, on occurrence of a specified event, or on demand; b) The duty or responsibility obligates a particular entity, leaving it little or no discretion to avoid the future sacrifice; and c) The transaction or other event obligating the entity has already happened. Getty Health insurance. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations. The policyholder selects the accounts into which the premium payments are to be made. This was formerly the Health Care Financing Administration. You will usually see a note of what the allowed amount/allowed charge is on the explanation of benefits you receive from your insurance company, and it typically comes after the amount that the provider bills (which is their non-negotiated rate). Examples are flood and earthquake coverage. Health insurance, so you don't have to worry about doctor's fees, hospital bills, or prescription medicine costs. Credit - individual or group policies that provide benefits to a debtor for full or partial repayment of debt associated with a specific loan or other credit transaction upon disability or involuntary unemployment of debtor, except in connection with first mortgage loans. Insured - party(ies) covered by an insurance policy. Long-Term Care - policies that provide coverage for not less than one year for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital, including policies that provide benefits for cognitive impairment or loss of functional capacity. Loss Reserves - an estimate of liability or provision in an insurer's financial statement, indicating the amount the insurer expects to pay for losses incurred but not yet reported or reported claims that haven't been paid. Exclusive, industry-focused manuals, data, and more. Annuity - a contract providing income for a specified period of time, or duration of life for a person or persons. If your medication is not included on a formulary tier, it is not covered by a plan. Life Endowment - insurance that pays the same benefit amount should the insured die during the term of the contract, or if the insured survives to the end of the specified coverage term or age. Continuing Care Retirement Communities - senior housing arrangements that in addition to housing include some provision for skilled nursing care. Key-Persons Insurance - a policy purchased by, for the benefit of, a business insuring the life or lives of personnel integral to the business operations. Individual Annuities Special - contracts with certain noteworthy attributes. A Preferred Provider Organization (PPO) is a type of insurance plan with a broader network of doctors. This includes policies providing only nursing home care, home health care, community based care, or any combination. These types of health insurance plans require you to select a primary care provider (PCP) from within the network. This is strictly supplemental coverage and cannot duplicate any benefits provided by Medicare. Commercial Earthquake - earthquake property coverage for commercial ventures. Irrevocable Beneficiary - a life insurance policy beneficiary who has a vested interest in the policy proceeds even during the insured's lifetime because the policy owner has the right to change the beneficiary designation only after obtaining the beneficiary's consent. Direct Writer - an insurance company that sells policies to the insured through salaried representatives or exclusive agents only; reinsurance companies that deal directly with ceding companies instead of using brokers. Insurance Glossary - U.S. Office of Personnel Management Visiting a doctor in Germany | Expatica All Marketplace plans cover prescription drugs. Continuation of Care Requirement - statutory or contractual provision requiring providers to deliver care to an enrollee for some period following the date of a Health Plan Company's insolvency. Can be classified into two broad categories: Defense and Cost Containment (DCC) and Adjusting and Other (AO). Construction and Alteration Liability - covering the liability of an insured to persons who have incurred bodily injury or property damage from alterations involving demolition, new construction or change in size of a structure on the insured's premises. Disability Income - Short-Term - policies that provide a weekly or monthly income benefit for up to five years for individual coverage and up to one year for group coverage for full or partial disability arising from accident and/or sickness. A health savings account (HSA) is a bank account you own that you can use to pay for eligible health care expenses or to save and invest for retirement. Nuclear Energy Liability - coverage for bodily injury and property damage liability resulting from the nuclear energy material (whether or not radioactive) on the insured business's premises or in transit. Contract Reserves - reserves set up when, due to the gross premium structure, the future benefits exceed the future net premium. Coverage also includes inspection of the equipment. Professional Errors and Omissions Liability - coverage available to pay for liability arising out of the performance of professional or business related duties, with coverage being tailored to the needs of the specific profession. Medicare Advantage Part C plans offer the same hospital and medical benefits as original Medicare, often in combination with prescription drug coverage, and other programs. We're here to help. Asset Risk - in the risk-based capital formula, risk assigned to the company's assets. Tier 1 usually covers generic medications, making this the lowest-cost tier. Face Amount - the value of a policy to be provided upon maturity date or death. Chartered Property Casualty Underwriter (CPCU) - a professional designation awarded by the American Institute of Property and Casualty Underwriters to persons in the property and liability insurance field who pass a series of exams in insurance, risk management, economics, finance, management, accounting, and law. The account is opened through the HSA provider chosen by your employer. Captive Insurer - an insurance company established by a parent firm for the purpose of insuring the parent's exposures. Select a state or jurisdiction for insurance department contact information. Research and analysis on important insurance issues. Medicaid - policies issued in association with the Federal/State entitlement program created by Title XIX of the Social Security Act of 1965 that pays for medical assistance for certain individuals and families with low incomes and resources. Group Annuities Deferred Non- Variable and Variable - an annuity contract that provides an accumulation based on both (1) funds that accumulate based on a guaranteed crediting interest rates or additional interest rate applied to designated considerations, and (2) funds where the accumulation vary in accordance with the rate of return of the underlying investment portfolio selected by the policyholder. For availability, costs and complete details of coverage, contact a licensed agent or Cigna Healthcare sales representative. Other Liability - coverage protecting the insured against legal liability resulting from negligence, carelessness, or a failure to act resulting in property damage or personal injury to others. Indemnification is on a proportional or non-proportional basis. Viatical Settlements - contracts or agreements in which a buyer agrees to purchase all or a part of a life insurance policy. Hazard - circumstance which tends to increase the probability or severity of a loss. Amount of payment is determined by subtracting the actual premium expense from the premium charged. If youre looking for lower monthly premiums and are willing to pay a higher deductible when you get care, an EPO plan might be right for you. International - includes all business transacted outside the U.S. and its territories and possessions where the appropriate line of business is not determinable. View actions considered by committees, task forces, and subgroups, as well as charges, schedules, and staff links. The list below includes definitions for some of the . Advisory Organization - a group supported by member companies whose function is to gather loss statistics and publish trended loss costs. Equity Indexed Annuity - a fixed annuity that earns interest or provides benefits that are linked to an external reference or equity index, subject to a minimum guarantee. Here is a brief guide to some of the most common health insurance terms 101 you may come across. The coverage reshuffle: Health insurance projections & health care Replacement Cost - the cost of replacing property without a reduction for depreciation due to normal wear and tear. Many of the terms you encounter when dealing with health insurance are not familiar. Auto Liability - coverage that protects against financial loss because of legal liability for motor vehicle related injuries (bodily injury and medical payments) or damage to the property of others caused by accidents arising out of ownership, maintenance or use of a motor vehicle (including recreational vehicles such as motor homes). With this type of account, you (along with your employer, in some cases) can make contributions up to a maximum of $3,400 for an individual or $6,750 for a family in 2017 (the cap on contributions changes every year) and an additional $1,000 for adults over 55. Benefits often include a stated dollar amount for glasses and contacts. Superfund - federal act mandating retroactive liability for environmental pollution where responsible party maintains accountability for environmental clean-up regardless of length of time since polluting event occurred. Asset - probable future economic benefits obtained or controlled by a particular entity as a result of past transactions or events. On the explanation of benefits you receive from your insurance company, you will see the providers billed amount/charge, usually followed by the allowed amount/charge that the insurer (and you) actually pay. Access to every published model law, regulation, and guideline. Morbidity risk excludes the potential for an individual's death, but includes the potential for an illness or injury that results in death. Medical Professional Liability - insurance coverage protecting a licensed health care provider or health care facility against legal liability resulting from the death or injury of any person due to the insured's misconduct, negligence, or incompetence in rendering professional services. Health Insurance Glossary: Terms to Know - secondscount.org Insurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. Health Excess/Stop Loss - this type of insurance may be extended to either a health plan or a self-insured employer plan. High or low risk candidates may qualify for extra or discounted rates based on their deviation from the standard. An investment shall not be deemed to be foreign if the issuing person, qualified primary credits source or qualified guarantor is a domestic jurisdiction or a person domiciled in a domestic jurisdiction, unless: a) The issuing person is a shell business entity; and b) The investment is not assumed, accepted, guaranteed or insured or otherwise backed by a domestic jurisdiction or a person, that is not a shell business entity, domiciled in a domestic jurisdiction. New terms will be added to the glossary over time. May include losses that have been reported to the reporting entity but have not yet been entered into the claims system or bulk provisions. Subsequent Event - events or transactions that occur subsequent to the balance sheet date, but before the issuance of the statutory financial statements and before the date the audited financial statements are issued, or available to be issued. Costs can vary by hospital or facility and location, so its important to know if your policy has coinsurance. Find Missouri health insurance options at many price points. A health maintenance organization (HMO) health plan gives you a local network of doctors, hospitals, and other health care professionals and facilities to choose from. Individual Health - health insurance where the policy is issued to an individual covering the individual and/or their dependents in the individual market. If you submit the claim, you are usually reimbursed, while if your doctor does so, they are paid. A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. FEMA - Federal Emergency Management Agency - an independent agency, tasked with responding to, planning for, mitigating and recovery efforts of natural disasters. Underwriting - the process by which an insurance company examines risk and determines whether the insurer will accept the risk or not, classifies those accepted and determines the appropriate rate for coverage provided. Mortgage Guaranty - insurance that indemnifies a lender for loss upon foreclosure if a borrower fails to meet required mortgage payments. Credit - Credit Default - coverage purchased by manufacturers, merchants, educational institutions, or other providers of goods and services extending credit, for indemnification of losses or damages resulting from the nonpayment of debts owed to them for goods or services provided in the normal course of their business. Loss Frequency - incidence of claims on a policy during a premium period. Auto Physical Damage - motor vehicle insurance coverage (including collision, vandalism, fire and theft) that insures against material damage to the insured's vehicle. Carrying Value (Amount) - the SAP book value plus accrued interest and reduced by any valuation allowance and any nonadmitted adjustment applied to the individual investment. A generic medication is a prescription medication that has the same active-ingredient formula as a brand-name medication. I had never heard of many of those terms before. Ceding Company - an insurance company that transfers risk by purchasing reinsurance. Any additional costs that are not covered by insurance when you visit your doctor, hospital or pharmacy are out-of-pocket costs. Health insurance has its own terminology, which can be confusing. Group Accident and Health - coverage written on a group basis (e.g., employees of a single employer and their dependents) that pays scheduled benefits or medical expenses caused by disease, accidental injury or accidental death. Business Auto - coverage for motor vehicles, other than those in the garage business, engaged in commerce. Members are allowed benefits for non-participating provider services on an indemnity basis with significant copayments and providers are often, but not always, paid on a discounted fee for service basis. Unpaid Losses - claims that are in the course of settlement. Investment Income Gross - shall be recorded as earned and shall include investment income collected during the period, the change in investment income due and accrued, the change in unearned investment income plus any amortization (e.g., discounts or premiums on bonds, origination fees on mortgage loans, etc.).

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