List of specified amounts payable for surgical procedures, dismemberments, ancillary expenses, etc. in hospital and medical reimbursement policies.
Second Surgical Opinion
Cost containment technique to assist patients and insurance companies in determining whether a recommended procedure is necessary, or if an alternative method of treatment could accomplish the same result. Some health policies require a second opinion before procedures will be covered, and many policies pay for the second opinion.
Medical services provided by physicians not having first contact with patients. Examples include specialists such as urologists, cardiologists, etc.
Coverage providing payment for charges not covered by the primary policy or plan.
Insurance plan where an employer pays the claims rather than an insurance company.
Bodily injury of the insured inflicted on himself.
Area in which a health plan can provide services.
Short-Term Disability Income Policy
Disability income policy with benefits payable for "Short Term," (defined as less than two years), as opposed to a Long Term Disability Income policy.
Short-Term Disability Insurance
Group or individual policy written to cover disabilities of 13 or 26 weeks duration. However coverage for as long as two years is not uncommon.
Including physical illness, disease, pregnancy, but not including mental illness.
Form of Health Insurance against loss by illness or disease, but does not include accidental bodily injury.
Skilled Nursing Care
Daily nursing and rehabilitative care performed only by or under supervision of skilled professional or technical personnel. Includes administering medication, medical diagnosis and minor surgery.
Small Group Pooling
Combination in one pool of several small group businesses. Especially used for computing more accurate premium rates for members of the pool.
Staff Model HMO
HMO where physicians are employed and all premiums are paid to the HMO. The HMO then compensates physicians on a salary and bonus arrangement.
Standard Class Rate (SCR)
Rate arrived at by using a base rate per participant multiplied by a factor to allow for group demographic information.
Type of reinsurance taken out by a health plan or self-funded employer plan. Plan can be written to cover excess losses over a specified amount either on a specific or individual basis, or on a total basis for the plan over a period of time such as one year.
Term has two meanings: 1) A person or organization who pays the premiums, and 2) person whose employment makes them eligible for membership in the plan.
Agreement describing individual's benefits under a health care policy.
Summary Plan Description
Recap or summary of benefits provided. Used most often with employees covered by self-funded plans.
Additional services purchased over and above the basic coverage.
Surgical Insurance Benefits
Form of Health Insurance against loss resulting from surgical expenses.
Part of basic medical expense plan itemizing various surgical procedures and monetary benefit allocated to the procedure.
Facility separate from a hospital providing outpatient surgical services.