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Glossary of Frequently
Used Health Insurance Terms
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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 |
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Accredited (Accreditation):
A "seal of approval" for health care facilities.
Being accredited means that a facility has met certain quality
standards. These standards are set by private, nationally
recognized groups that check on the quality of care at health
care facilities.
Administrative Services Only
(ASO):
An arrangement in which an employer hires a third party to deliver
employee benefit administrative services to the employer.
These services typically include health claims processing and
billing. The employer bears the risk for health care expenses
under an ASO plan.
Admitting Physician :
The doctor responsible for admitting you to a hospital or other
inpatient health facility.
Admitting Privileges:
The right granted to a doctor to admit patients to a particular
hospital
Ambulatory Care:
All types of health services that do not require an overnight
hospital stay
Ancillary Services
Services, other than those provided by a physician or hospital,
which are related to a patient’s care, such as laboratory work,
x-rays and anesthesia
Any Willing Provider
Laws:
Legislation that requires health care plans to accept into their
PPO and HMO networks any provider willing to agree to the network's
terms and conditions
Appeal:
Request made to a payer to reconsider a decision, such as a
claim denial or denied prior authorization request. Most
appeals must be submitted in writing within a specified period.
Assignment of Benefits:
When an insured person assign benefits, they sign a document
allowing the hospital or doctor to collect health insurance
benefits directly from the health insurance company. Otherwise,
the insured person pays for the treatment and is later reimbursed
by the health insurance company. |
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Beneficiary:
A person eligible for benefit under a health insurance policy
Benefit:
Amount payable by the insurance company to a claimant, assignee,
or beneficiary when the insured suffers a loss
Benefit
Cap:
Total dollar amount that a payer will reimburse for covered
health care services during a specified period, such as one
year
Board Certified:
A physician who has passed examinations given by a medical specialty
group and who has, as a result, been certified as a specialist
in this area of practice
Capitation:
Capitation represents a fixed monthly dollar amount that a Health
Maintenance Organization (HMO) pays to a group of health care
providers who have contracted with the HMO. The amount
of this fixed dollar amount depends upon the number of HMO enrollees
who have chosen this group of health care providers for "primary
care" services under the HMO plan. This fixed dollar
amount does not vary with how much HMO enrollees use (or don't
use) services offered by this group of HMO providers.
Not all HMO utilize capitation payments.
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 |
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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
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. For example, 80% coinsurance may apply
after a $500 deductible has been satisfied.
Consolidated Omnibus Budget Reconciliation Act (COBRA):
The Consolidated Omnibus Budget Reconciliation Act of 1985,
commonly known as COBRA, requires group health plans with
20 or more employees to offer continued health coverage for
employees and their dependents for 18 months after the employee
leaves the job. Longer durations of continuance are
available under certain circumstances. If a former employee
opts to continue coverage under COBRA, the former employee
must pay the entire premium, plus a 2% administration charge.
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". |
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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.
Coordination of Benefits (COB):
A provision in the contract that applies when
a person is covered under more than one health insurance plan.
It requires that payment of benefits be coordinated by all plans
to eliminate over-insurance or duplication of benefits.
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.
Co-payment:
Co-payment is a predetermined fee, in addition to what health
insurance covers, that an individual pays for health care services.
For example, a PPO may require a $20 "co-payment"
for normal services delivered during a physician office visit.
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 |
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Credentialing:
The process used by health insurance companies to examine and
verify the medical qualifications of health care providers who
want to participate in the PPO or HMO network
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
Current Procedural Terminology (CPT)
A system of terminology and coding developed by the American
Medical Association (AMA) that is used for describing, coding,
and reporting medical services and procedures
Custodial
Care:
Personal care, such as bathing, cooking, and shopping
Deductible:
Cost-sharing arrangement between an insured person and health
insurance company in which the insured person will be required
to pay a fixed dollar amount of covered expenses each year before
the health insurance company will reimburse for covered health
care expenses. Generally, an insured person is responsible
for a deductible each calendar year.
Deductible
Carry Over Credit:
Charges applied to the deductible for services during the last
3 months of a calendar year which may be used to satisfy the
following year’s deductible
Defensive Medicine:
Use of unnecessary treatments, procedures or other medical services
by doctors to minimize the threat of a malpractice lawsuit
Denial Of Claim:
Refusal by a health insurance company to honor a request by
an individual (or his or her provider) to pay for health care
services obtained from a health care professional |
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Dependent:
A covered person who relies on another person for support or
obtains health coverage through a spouse or parent who is the
covered person under a health plan
Designated
Facility:
A facility which has an agreement with a health insurance plan
to render approved services (Organ transplants are the most
common example.). The facility may be outside a covered
person’s geographic area.
Discharge Planning:
Medical personnel of a health plan working with the attending
physician and hospital staff to assess alternatives to hospitalization,
evaluate appropriate settings for care, and arrange for the
discharge of a patient, including planning for subsequent care
at home or in a skilled nursing facility. The goal is
to determine when patients are ready to go home, and to provide
a more comfortable, cost-efficient setting for continued treatment.
Disenroll:
Ending a person's health care coverage with a health plan
Effective Date:
The date health insurance coverage begins
Eligible
Dependent:
A dependent of a covered person (spouse, child, or other dependent)
who meets all requirements specified in the contract to qualify
for coverage and for who premium payment is made
Eligible
Expenses:
The lower of the reasonable and customary charges or the agreed
upon health services fee for health services and supplies covered
under a health plan
Employee Assistance Programs
(EAPs):
Mental health counseling services that are sometimes offered
by insurance companies or employers. Typically, individuals
or employers do not have to directly pay for services provided
through an employee assistance program.
Enrollee:
The person who is the primary insured. Under an individual
or family policy, this person is the applicant. Under
an employer-sponsored group health policy, this person
is the employee. |
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Episode of Care:
The health care services given during a certain period of time,
usually during a hospital stay
Exclusions and
Limitations:
Medical services that are either not covered or limited in benefit
by a health insurance insurance policy
Exclusion
Period:
A period of time when an insurance company can delay coverage
of a pre-existing condition. Sometimes this is called a pre-existing
condition waiting period.
Explanation of Benefits
(EOB):
Statement sent by health plans to persons who have experienced
a claim under the health plan. The explanation of
benefits (EOB) details the charges for the services received,
the amount the health insurance company will pay for those services,
and the amount the insured person will be responsible for paying.
Fee-for-Service:
A payment system for health care where the provider is paid
for each service rendered rather than a pre-negotiated amount
for each patient
Fee Schedule:
A complete listing of fees used by health plans to pay doctors
or other providers
First Dollar Coverage:
Refers to not having to meet a calendar year deductible prior
to receiving reimbursement or payment for a medical service
Formulary:
A list of certain drugs and their proper dosages. Under
most health plans, better benefits are provided for formulary
drugs than are provided for non-formulary drugs
Full-Time
Student:
Under a health plan, an eligible dependant child student (typically
age 19 or older) who meets the health plan's criteria of "full-time."
Such criteria normally typically includes minimum credit hour
requirements (such as 12 credit hours in a semester) and a maximum
age (age 23 is typical.).
Gag
Rule Laws:
Special laws that make sure that health plans let doctors tell
their patients complete health care information. This
includes information about treatments not covered by the health
plan. |
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Gatekeeper:
A primary care physician in a managed care environment who is
responsible for managing the patient's overall care and who
must authorize all specialist referrals. In most health
maintenance organizations (HMOs), the secondary care is not
covered by insurance if the primary care physician does not
approve it.
Grievance:
Request made to a health plan to reconsider coverage of a health
care service that the health plan has not interpreted to be
a covered benefit
Group Health Plan:
A health plan that provides health coverage to employees and
their families, and is supported by an employer or employee
organization
Guaranteed Issue:
Under guarantee issue, a health insurance company or HMO must
issue coverage to an applicant regardless of prior medical history.
In Illinois and Indiana, small employers (defined as 2 to 50
employees) cannot be refused coverage for their employees regardless
of the medical history of one or more employees.
HCFA Common Procedure Coding System (HCPCS):
Name given to CPT codes (Level I), alphanumeric codes (Level
II), and local codes (Level III) used by payers and providers
for billing purposes. Within the industry, most refer
to Level II national codes as HCPCS codes.
Health
Care Provider:
A doctor, hospital, laboratory, nurse, or anyone who delivers
medical or health-related care
Health Employer
Data and Information Set (HEDIS):
A set of standard performance measures that provides information
about the quality of a health plan. These measures are
used to compare managed care plans.
Health
Insurance Portability & Accountability Act (HIPAA):
A law passed in 1996, which is also called the "Kassebaum-Kennedy"
law. This law expanded health care coverage for persons
who have lost their job, or move from one job to another.
HIPAA protects persons who have pre-existing medical conditions,
and/or problems, based on past or present health, in getting
health insurance coverage. |
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Health Maintenance Organization (HMO):
Prepaid health plans which cover doctors' visits, hospital stays,
emergency care, surgery, preventive care, checkups, lab tests,
X-rays, and therapy. In a HMO, one must choose a primary
care physician who coordinates all care and makes referrals
to any specialists that may be required. In a HMO, one
must use the doctors, hospitals and clinics that participate
in your plan's network. No benefits are paid for non-emergency
benefits provided outside the HMO network.
Health
Savings Account (HSA):
Operating similarly to IRAs, HSAs are tax-advantaged savings
accounts for health care services. A person must enroll
in a qualified High-Deductible Health Plan (HDHP) before they
can establish an HSA.
High Deductible Health
Plan (HDHP)
A person must be enrolled in a qualified High-Deductible Health
Plan (HDHP) before they can establish a Health Savings Account
(HSA). Not all high-deductible health plans qualify for
purposes of establishing HSA eligibility. A qualified
HDHP benefit design must conform to various federally-mandated
requirements, such as a minimum $1000 deductible and a lack
of first-dollar benefit provisions.
Home Health
Care:
Services given at home to aged, disabled, sick, or convalescent
individuals not needing institutional care. The most common
types of home care are visiting nurse services and speech, physical,
occupational, and rehabilitation therapy. These services
are provided by home health agencies, hospitals, or other community
organizations.
Hospice Care:
Care for the terminally ill and their families, in the home
or a non-hospital setting, that emphasizes alleviating pain
rather than a medical cure
Hospital Care:
Reimbursement for both inpatient and outpatient medical care
expenses incurred in a hospital. Inpatient Benefits include;
Charges for room and board, charges for necessary services and
supplies sometimes referred to as 'hospital extras,' 'other
hospital extras,' 'miscellaneous charges,' and 'ancillary charges.
Outpatient Benefits include; surgical procedures, rehabilitation
therapy, and physical therapy.
Hospital-Surgical
Coverage:
A form of health insurance that offers coverage of certain costs
related to hospitalization and surgical procedures.
A hospital-surgical plan does not cover other types of medical
services, such as physician office visits and outpatient prescription
drugs..
Incurral Date:
The date on which health care services are provided to a covered
person. The incurral date, not the date on which the insurance
company pays a health care claim, is the critical date in determining
health insurance benefits. For example, a health insurance
company will not pay a claim for health care services incurred
prior to the effective date of the health insurance coverage.
Indemnity Health Plan:
Indemnity health insurance plans are also called "fee-for-service."
These are the types of plans that primarily existed before the
rise of HMOs and PPOs. With indemnity plans, the
individual pays a pre-determined percentage of the cost of health
care services, and the health plan pays the other percentage.
For example, an individual might pay 20% for services and the
insurance company pays 80%. The fees for services are
defined by the health care providers and vary from physician
to physician and hospital to hospital. |
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Independent Practice
Associations (IPA):
An IPA is a type of HMO in which care is provided by independent
physicians who contract with the HMO. This contrasts with
the "staff model" HMO, in physicians are employees
of the HMO.
Inpatient Care:
Health care that you get when you stay overnight in a hospital
Insured:
A person who has obtained health insurance coverage under a
health insurance plan
International Classification
of Diseases, 9th Revision, Clinical Modification (ICD-9-CM):
Coding system maintained by the National Center for Health Statistics
and the Center for Medicare and Medicaid Services (CMS).
This coding system differentiates diagnostic conditions and
is used by hospitals, governments, health insurance plans, and
health care providers around the world.
Lifetime Maximum:
A cap on the benefits paid for the duration of a health insurance
policy. Many policies have a lifetime limit of $5 million,
which means that the insurer agrees to cover up to $5 million
in covered services over the life of the policy. Once
the $5 million maximum is reached, no additional benefits are
payable.
Limited Policy:
A policy that covers only specified accidents or sicknesses
(e.g. a cancer policy)
Major
Medical:
Health insurance coverage for expenses associated with hospital
confinements, surgeries and/or medical conditions requiring
a broad range of medical services and supplies
Managed
Care:
An organized way to manage costs, use, and quality of the health
care system. The major types of managed care plans are
health maintenance organizations (HMOs) and preferred provider
organizations (PPOs).
Medicaid:
Federal and state health insurance program for low-income individuals
who meet established eligibility criteria (programs vary from
state to state)
Medical Necessity:
Medical information justifying that the service rendered or
item provided is reasonable and appropriate for the diagnosis
or treatment of a medical condition or illness
Medicare:
Federal health insurance program for the elderly (age 65 and
older), certain disabled individuals, and those with end-stage
renal disease. Medicare is administered by the Center
for Medicare and Medicaid Services (CMS), formerly the Health
Care Financing Administration (HCFA). |
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Medicare Supplement:
A supplemental insurance policy to help cover the difference
between approved medical charges and benefits paid by Medicare.
These plans are also known as "Medi-gap" plans.
Medical Savings Account (MSA):
A tax-advantaged personal savings account used in conjunction
with a high deductible health policy. Individuals can
contribute money to this account on a pre-tax basis to set aside
money for qualified medical care and expenses, including annual
deductibles and co-payments.
Medically Necessary:
Many insurance policies will pay only for treatment that is
deemed "medically necessary" to restore a person's
health. For instance, many health insurance policies will
not cover routine physical exams or plastic surgery for cosmetic
purposes.
Medigap:
A supplemental insurance policy to help cover the difference
between approved medical charges and benefits paid by Medicare.
These plans are also known as "Medicare Supplement"
plans..
National Association of Insurance Commissioners
(NAIC):
A national organization of state officials charged with regulating
insurance. NAIC was formed to promote national uniformity
in insurance regulations.
National Committee
for Quality Assurance (NCQA):
A national group responsible for devising and monitoring quality
measurements and standards for health care entities
National Drug Code (NDC):
Numerical coding system for drug identification. NDC numbers
are assigned by the Food and Drug Administration (FDA) and are
typically used to bill payers for the drugs provided to health
care beneficiaries.
Network:
Groups of physicians, hospitals and other health care providers
working with the health plan to offer care at negotiated rates
Network Provider:
Physicians, hospitals or other providers of medical services
that have agreed to participate in a network, to offer their
services at negotiated rates, and to meet other negotiated contractual
provisions. Also called "participating provider." |
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Noncancellable
Policy:
A policy that guarantees you can receive insurance, as long
as you pay the premium. It is also called a guaranteed
renewable policy.
Open Enrollment:
A period each year during which employees have an opportunity
to change their employer-provided health care coverage.
They usually can choose among various plans from different health
insurance providers.
Out-Of-Network:
Health care services received outside the HMO or PPO network
Out-Of-Plan:
This phrase usually refers to physicians, hospitals or other
health care providers who are considered non-participants in
an insurance plan (usually an HMO or PPO). Depending on
an individual's health insurance plan, expenses incurred by
services provided by out-of-plan health professionals may not
be covered, or covered at a reduced benefit level.
Out-of-Pocket Costs:
Insured health care costs for which one is responsible, because
of the application of deductibles, coinsurance and co-payments
Out-of-pocket maximum:
Total dollar amount an insured will be required to pay for covered
medical services during a specified period, such as one year.
The out-of-pocket maximum may also be called the stop-loss limit
or catastrophic expense limit.
Participating
Provider:
A health care provider who has been contracted to render medical
services or supplies to insured persons at a pre-negotiated
fee. Providers include hospitals, physicians, and other
medical facilities that are part of a PPO or HMO network.
Policy:
The insurance agreement or contract
Portability:
The ability for an individual to transfer from one health insurer
to another health insurer with regard to pre-existing conditions
or other risk factors |
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Pre-Admission Review:
A review of an individual's health care status or condition,
prior to an individual being admitted to a hospital or inpatient
health care facility. Pre-admission reviews are often
conducted by case managers or insurance company representatives
(usually nurses) in cooperation with the individual, his or
her physician or health care provider, and hospitals.
Pre-Admission Testing:
Medical tests that are completed for an individual prior to
being admitted to a hospital or inpatient health care facility
Pre-Authorization:
Under a pre-authorization provision of a health insurance policy,
the insured must contact the health insurance company prior
to a hospitalization or surgery, and receive authorization for
the service.
Pre-Certification:
This is a requirement that a insured person call their health
insurance company and advise them a doctor has stated certain
medical treatment is required. This is done before receiving
treatment from the doctor or hospital. A health insurance
policy will normally list the medical conditions that require
pre-certification before receiving treatment. When pre-certification
is not received, benefits will be reduced or possibly not covered.
Pre-existing Condition:
A health problem that existed before the date your insurance
became effective. Each health insurance company uses its
own particular definitions of pre-existing condtiion.
However, the following statement is in line with most insurance
company provisions: "A pre-existing condition is
a medical condition that would cause a normally prudent person
to seek treatment during the twelve months prior to the beginning
of coverage."
Preferred Provider Organization
(PPO): A network of health care providers with which
a health insurer has negotiated contracts for its insured population
to receive health services at discounted costs. Health
care decisions generally remain with the patient as he or she
selects providers and determines his or her own need for services.
Patients have financial incentives to select providers within
the PPO network.
Pregnancy Care:
Federal maternity legislation, enacted in 1978, requires that
employers engaged in interstate commerce who have 15 or more
employees provide the same benefits for pregnancy, childbirth,
and related medical conditions as for any other sickness or
injury. This includes all employers who are, or become,
subject to Title VII of the Civil Rights Act of 1964. |
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Premium:
The amount you or your employer pays in exchange for health
insurance coverage
Preventive Care:
An approach to health care which emphasizes preventive measures
and health screenings such as routine physicals, well-baby care,
immunizations, diagnostic lab and x-ray tests, pap smears, mammograms
and other early detection testing. The purpose of offering
coverage for preventive care is to diagnose a problem early,
when it is less costly to treat, rather than late in the stage
of a disease when it is much more expensive, or too late to
treat.
Primary Care Physician (PCP):
Under a health maintenance organization (HMO) plan, the primary
care physician is usually an insured person's first contact
for health care. This is often a family physician, internist,
or pediatrician. A primary care physician monitors patient
health, treats most patient health problems, and refers patients,
if necessary, to specialists.
Prior authorization
Review of need for health care items or services before services
are rendered or products are provided. This refers to
a decision made by the health plan to cover or not cover the
charges before the services are provided.
Provider
Any person (doctor or nurse) or institution (hospital, clinic,
or laboratory) that provides medical care
Reasonable and Customary (R &C) Charge:
A term used to refer to the commonly charged or prevailing fees
for health services within a geographic area. A fee is
generally considered to be reasonable if it falls within the
parameters of the average or commonly charged fee for the particular
service within that specific community. "Reasonable
and Customary (R&C) Charge" essentially means the same
thing as "Usual and Customary (U&C) Charge."
Referral:
An OK from the primary care physician for the patient to see
a specialist or get certain services. In many HMO plans,
the insured person needs to get a referral before they get care
from anyone except the primary care physician. If the
referral is not received, the HMO may cover resulting expenses. |
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Risk:
For a health insurance company, risk is the chance of loss,
the degree of probability of loss or the amount of possible
loss. For an individual, risk represents such probabilities
as the likelihood of surgical complications, medications' side
effects, exposure to infection, or the chance of suffering a
medical problem because of a lifestyle or other choice.
For example, an individual increases his or her risk of getting
cancer if he or she chooses to smoke cigarettes.
Schedule of Benefits and Exclusions:
A health insurance listing of the benefits which are covered
under the policy guidelines as well as services which are not
provided under the policy
Second Surgical Opinion:
This is an opinion provided by a second physician, when one
physician recommends surgery to an individual. Most health
insurance policies cover second surgical opinions.
Self-insured:
The self-insured employer assumes risk for health care expenses
in a plan that is self-administered or administered through
a contract with a third-party organization. This form
of coverage is regulated by the Employee Retirement Income Security
Act of 1974. Hence, self-insured health plans fall under
federal, rather than state, regulation.
Service
Area:
The area where a health plan accepts members. For HMOs,
it is also the area where services are provided. A health
plan may terminate coverage for persons who move out of the
plan's service area.
Skilled Nursing Facility:
A licensed institution that provides regular medical care and
treatment to sick and injured persons. Daily medical records
are kept and patients are under the care of a licensed physician.
Special Benefit Networks:
Provider networks for particular services, such as mental health,
substance abuse, or prescription drugs
Staff
Model:
Staff model is a type of HMO in which care is provided by physicians
who are employees of the HMO. This contrasts with the
"independent practice association (IPA)" HMO, in which
independent physicians contract with the HMO. |
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State Insurance
Department:
An administrative agency that implements state insurance laws
and supervises (within the scope of these laws) the activities
of insurance companies operating within the state
State-Mandated
Benefits:
Benefits for a variety of medical conditions that a given state
requires of health insurance policies sold in that state
Stop-loss Provisions:
A limit in a health insurance policy that provides for 100%
payment of expenses after total patient out-of-pocket expenses
exceed a certain contractual dollar amount
Third-Party Payer:
Any payer of health care services other than the insured person.
This can be an insurance company, HMO, PPO, or the federal government.
Underwriting:
The act of reviewing and evaluating prospective insured persons
for risk assessment and appropriate premium
Usual
and Customary (U&C) Charge:
A term used to refer to the commonly charged or prevailing fees
for health services within a geographic area. A fee is
generally considered to be reasonable if it falls within the
parameters of the average or commonly charged fee for the particular
service within that specific community. "Usual
and Customary (R&C)" essentially means the same thing
as "Reasonable and Customary (R&C) Charge."
Utilization Review:
A mechanism by which the appropriateness, necessity, and quality
of health care services are monitored by both insurers and employers
Waiting Period:
A period of time when the health plan does not cover a person
for a particular health problem
Well-Baby Care:
Preventative health services, including immunizations, for young
children within an age range specified by the health plan
Wellness Office Visit:
A physician’s office visit which is not prompted by sickness
or injury
Workers Compensation:
Insurance that employers are required to have to cover employees
who get sick or injured on the job
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