Some health insurance companies may use terms with a diffferent meaning and practices may vary among health insurance companies. Check the policy/certificate/evidence of coverage or call the health insurance company or us to obtain confirmation in a particular case.

# |  A |  B |  C |  D |  E |  F |  G |  H |  I |  J |  K |  L |  M
N |  O |  P |  Q |  R |  S |  T |  U |  V |  W |  X |  Y |  Z

Accidental injuries
unintentional internal or external injuries, e.g., strains, animal bites, burns, contusions and abrasions which result in trauma to the body. Accidental injuries are different from illness related conditions.

Acupuncture services
the treatment of a disease or condition by inserting special needles along specific nerve pathways for therapeutic purposes. The placement of the needles varies with the disease or condition being treated.

Acute care
care that is provided in an office, urgent care setting, emergency room or hospital for a medical illness, accident or injury. Acute care may be emergency, urgent or non-urgent, but is not primarily preventive in nature.

Adverse selection
a tendency for higher than average bad risks to be issued coverage, e.g., an association plan where all members are eligible for enrollment without screening. The members with pre-existing health problems rush to join while the healthiest shop around. That increases average claims cost, causing the premiums to increase, causing the healthiest to shop around even more. Eventually, the plan is unaffordable for any good risk to consider buying and the whole wishful thinking scheme bites the dust. It is abandoned and the members must look elsewhere.

Aggregate maximum
in some policies, "aggregate maximum amount means the maximum amount payable... for any one covered injury or sickness for each insured person... ". Because one major illness or major injury could exceed this aggregate amount, typically $500,000, it effectively negates the benefit of the lifetime maximum which is a higher figure.

Alcoholism/substance treatment center
a detoxification and/or rehabilitation facility licensed by the state to treat alcoholism/drug abuse.

Alternative/complimentary care
therapeutic practices that are not currently considered an integral part of conventional medical practice. Therapies are termed Complimentary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment. Alternative medicine includes, but is not limited to, Chinese or Ayurvedic medicine, herbal treatments, vitamin therapy, homeopathic medicine and other non-traditional remedies for treating diseases or conditions.

Ambulance
a specially designed and equipped vehicle used only for transporting the sick and injured. It must have customary safety and lifesaving equipment such as first aid supplies and oxygen equipment. The vehicle must be operated by trained personnel and licensed as an ambulance.

Ancillary services
services and supplies (in addition to room services) that hospitals, alcoholism treatment centers and other facilities bill for and regularly make available for the treatment of the member’s condition. Such services include, but are not limited to: • Use of operating room, recovery room, emergency room, treatment rooms and related equipment. • Drugs and medicines, biologics (medicines made from living organisms and their products), and pharmaceuticals. • Dressings and supplies, sterile trays, casts, and splints. • Diagnostic and therapeutic services. • Blood processing and transportation and blood handling costs and administration.

Anesthesia
the loss of normal sensation or feeling. There are two different types of anesthesia: • General anesthesia, also known as total body anesthesia, causes the patient to become unconscious or “put to sleep” for a period of time. • Local anesthesia causes loss of feeling or numbness in a specific area usually injected with a local anesthetic drug such as Lidocaine.

Anniversary date
(i) the annual date on which a group renews its coverage and optional coverages or other choices, e.g., employee waiting periods, can be changed. Usually this is the annual anniversary of when the policy was first in effect. (ii) for some individual policies, the annual date on which certain changes may occur, e.g., policyholder can change the deductible or health insurance company changes the premium.

Anthem Blue Cross and Blue Shield
Rocky Mountain Hospital and Medical Service, Inc., a Colorado insurance company doing business as Anthem Blue Cross and Blue Shield. Also referred to as “Anthem.”

Appeal
a process for reconsideration of the insurer’s decision regarding a member’s claim.

Association
(i) Because of different laws and regulations in each state, to facilitate the filing of policies and amendments in multiple states, some health insurance companies contract with an independent association,. e.g., a consumer association or special-interest lobbying association, to which they issue a master policy. A policy certificate is issued under the master policy to the health insurance buyer who must be a member of the association. A small membership fee is charged in addition to the premium or may be included in the premium. The fee is then paid by the health insurance company to the association. Of itself, this is a legal and proper procedure (ii) This legitimate process should not be confused with the dubious claims of some marketing operations who say that the price of their health insurance is lower than it otherwise would be because it was bought with an association's bulk buying power. Such a claim is considered by some observers to be a deceptive trade practice especially when combined with a lack of explanation as to significant coverage limitations in the plan which the consumer may overlook. There may be an association master policy from which the association member gets a policy certificate, but that does not reduce claims or other significant costs and so does not produce lower priced health insurance for association members. The consumer may end up with coverage that is inadequate and over-priced compared with what else is on the market. See the page on DISCOUNTS.

Authorization
approval of benefits for a covered procedure or service.

# | A | B | C | D | E | F | G | H | I | J | K | L | M
 | N | O | P | Q | R | S | T | U | V | W | X | Y | Z