A&H, A&S. Accident and Health Insurance, Accident and Sickness Insurance
Generic term for the field of Health Insurance
Life insurance riders allowing the policy's death benefits to offset expenses incurred in a convalescent or nursing home facility
Availability of medical care. Determined by availability of transportation, location, type of medical services in the area, etc.
Accident and Health Insurance (also referred to as A&H)
Another, older name for Health Insurance.
Accident and Sickness Insurance (also referred to as A&S)
Another, older term for Health Insurance.
Insurance against loss by accidental bodily injury to the insured.
Accidental Death and Dismemberment
(also referred to AD & D)
Policy or provision in Disability Income policy that pays a specified amount or a multiple of the weekly disability benefit should the insured die, lose his sight, or lose two limbs as the result of an accident. Lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.
Accidental Death Benefit
Extra benefit that, in general, equals the face of the contract or principal sum, payable in addition to other benefits in the event of death as the result of an accident.
Accidental Death Insurance
Form of insurance providing payment if the death of the insured results from an accident. Often combined with Dismemberment Insurance in a form called Accidental Death and Dismemberment.
Medicare term meaning the process of adding new members to a health plan.
Depending upon the policy, if an employee is not actively at work on the day the policy goes into effect, coverage does not begin until the employee returns to work.
Activities of Daily Living
Activities performed by individuals without assistance in the course of day to day living that include mobility, dressing, personal hygiene and eating.
Activities of Daily Living Standards
Standards assessing the ability of an individual to live independently, measuring the ability to perform unaided such activities as eating, bathing, toiletry, dressing, and walking. Standards are often discussed as a measurement or definition of eligibility for long term care.
Actual amount charged by a physician for medical services.
Medically necessary, skilled care provided by nursing and medical personnel to restore a person to good health.
Additional Drug Benefit List
Prescription drugs listed as commonly prescribed for patients' long-term use. Subject to review and revision by the health plan involved. Also referred to as drug maintenance list.
Additional Monthly Benefit
Riders added to disability income policies to providing additional benefits for the first year of a claim while the insured is waiting for commencement of Social Security benefits.
Adjusted Average Per Capita Cost (AAPCC)
Estimated average cost of Medicare benefits established on county basis. Factors include age, sex, Medicaid, institutional status, disability, and end stage renal disease status. Determines Medicare benefits payments to cost contractors.
Adjusted Community Rating (ACR)
Community rating adjusted by factors that are specific to a particular group. Also referred to as factored rating.
Number of hospital admissions for each 1,000 members of plan
Number of admissions to a hospital (includes outpatient and inpatient facilities).
Adult Day Care
Group program for functionally impaired adults. Meets health, social and functional needs in a setting other than adult's home.
Patient services, customized to the individual, required after hospitalization or rehabilitation.
For insurance purposes, date that a person's age changes. In majority of Life Insurance contracts, defined as the date midway between the insured's natural birth dates. For Health Insurance purposes, the age of the previous birth date is frequently used for rate determinations. Based upon the rating structure of the particular insurer, on the date of age change, a person's age may change to that of the last birth date, the nearer birth date, or the next birth date.
A measurement is used in underwriting; comparing the age and sex risk of medical costs of one group in relation to another. Higher than average risk of medical costs due to that factor is indicated by age/sex factor above 1.00. Conversely, a factor below 1.00 indicates lower than average risk.
Services other than hospital room and board, nursing, and physician services. (e.g. lab and x-ray work)