Health Insurance Glossary

Cancellation clause

A clause in an insurance contract which permits an insurer and/or an insured to cancel the contract before it is due to expire. The clause may provide for a return of premium in respect of the unused portion of the policy.

Care Plan

A written plan for one's health care

Case Management

A process whereby an insured person with specific health care needs is identified and a plan which efficiently utilizes health care resources is designed and implemented to achieve the optimum patient outcome in the most cost-effective manner.

Case Manager

A nurse, doctor, or social worker who arranges all services that are needed to give proper health care to a patient or group of patients.

Catastrophic Illness

A very serious and costly health problem that could be life threatening or cause life-long disability. The cost of medical services alone for this type of serious condition could cause financial hardship.

Centers of Excellence

Hospitals that specialize in treating particular illnesses, or performing particular treatments, such as cancer or organ transplants.

Certificate of Coverage

A document given to an insured that describes the benefits, limitations and exclusions of coverage provided by an insurance company.

Claim

Form submitted to a payer (by a health care provider or patient) to request payment for items or services.

Claims made policy

A policy which only pays claims that are notified to the insurer during a specified period.

Clinical Practice Guidelines

Reports written by experts who have carefully studied whether a treatment works and which patients are most likely to be helped by it

Co-insurance

Cost-sharing arrangement between an insured person and the health insurance company in which the insured person is required to pay a percentage of the cost for the health care services received. Coinsurance typically applies after satisfaction of a deductible.

Concurrent Review

Concurrent review involves monitoring the medical treatment and progress toward recovery, once a patient is admitted to a hospital, to assure timely delivery of services and to confirm the necessity of continued inpatient care. This monitoring is under the direction of medical professionals. Concurrent review is a component of "Utilization Review."

Contract Year

The period of time from the effective date of the contract to the expiration date of the contract. A contract year is typically 12 months long, but not necessarily from January 1 through December 31.

Coordinated Care

Links the treatments or services necessary to obtain an optimum level of medical care required by a patient and provided by appropriate providers. It is also another term for "managed care" used by federal government officials.

Cost Sharing

This occurs when the users of a health care plan share in the cost of medical care. Deductibles, coinsurance, and co-payments are examples of cost sharing.

Covered Benefit

A health service or item that is included in a health plan, and that is partially or fully paid by the health plan.

Covered Charges/Expenses

Most insurance plans, whether they are PPOs or HMOs, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures for which the insurer agrees to pay. They are listed in the policy.

Covered Person

An individual who meets eligibility requirements and for whom premium payments are paid for specified benefits of the contractual agreement.

Creditable Coverage

Any previous health insurance coverage that can be used to shorten the pre-existing condition waiting period. See "HIPPA".

Critical Access Hospital

A small facility that gives limited outpatient and inpatient hospital services to people in rural areas.

Custodial Care

Personal care, such as bathing, cooking, and shopping.



Contact Information

Medical Insurance Consultants
Park House
45 The Park
Yeovil
Somerset
BA20 1DF

T: 0800 163 870
E: [email protected]


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Accreditations

Medical Insurance Consultants Ltd is authorised and regulated by the Financial Conduct Authority and is entered on the Financial Services Register under reference 309026.

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