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calendar-year deductible
The amount of health care expenses that the insured person must pay before insurance payments for covered eligible expenses.
case management
A utilization management technique that addresses the medical necessity of care as well as alternative treatments or solutions, especially when the patient is likely to require very expensive treatment.
certificate of insurance
A document that describes the type and length of coverage provided by a group insurance policy that is given to each insured by the group policyholder.
chiropractic care
Not all plans cover chiropractors -- practitioners who manipulate the spine and other structures within the body to relieve pain and tension resulting from posture, stress or strain. Some plans offer chiropractic care as an optional benefit that you or your employees may choose to add at an additional cost.
claim
A request for payment under the terms of an insurance policy.
claim examiner
An insurance company employee/representative who is responsible for carrying out the claim examination process. Also known as claim approver, claim analyst, or claim specialist.
COBRA (Consolidated Omnibus Budget Reconciliation Act)
COBRA requires organizations with twenty or more employees to offer the continuation of group health benefits (Medical, Dental, Vision, and Medical Reimbursement Account) to employees (and covered dependents) upon experiencing a "Qualifying Event."
Employers are required to provide initial COBRA notification to covered employees and dependents. A letter detailing an individual's rights upon experiencing a "qualifying event" and an explanation of the conversion privilege. The legislation defines the following six situations as "Qualifying Events" that require COBRA continuation: - Termination of Employment
- Reduction of Work Hours
- Employee's Death
- Employee's Divorce (or legal separation in some states)
- Medicare Entitlement
- Change in "Dependent" Status
coinsurance provision
A specified percentage of the cost of treatment the insured is required to pay for all covered medical expenses remaining after the policy's deductible has been met.
commission
The amount of money, usually a percentage of the premiums, that is paid to an insurance agent for selling an insurance policy.
comprehensive major medical policy
A health insurance policy that covers both major medical expenses (i.e., hospitalization and surgeries) and basic medical expense coverages.
copay
The fee you pay for certain medical services or for each prescription. For example, you may pay $20 for an office visit or $10 to fill a prescription and the health plan covers the balance of the charges.
(1) A fee that many insurance plans require an insured to pay for certain medical services (such as a physician's office visit). (2) An amount that the insured must pay toward the cost of each prescription under a prescription drug plan.
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