Ohio Department of Insurance Consumer Services

 Health Insurance Glossary


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Access
Accreditation
Activities of daily living (ADLs)
Actual Charge
Actuary
Acute Care
Administrative Costs
Admitting Privileges
Advance Directive
Advanced Practice Nurse (APN)
Adverse drug event (error)
Adverse event
Adverse selection
Aftercare
Agent
Allied health personnel
Allopathic
Allowable costs
Alternative delivery
Alternative medicine
Ambulance restocking
Ambulatory care
Ambulatory payment classification (APC)
Ambulatory setting
Americans with Disabilities Act (ADA)
Ancillary
Anti-kickback statute
Antitrust
Any willing provider
Approved Charge
Approved health care facility or program
Association
Average length of stay (ALOS)
Bad debt
Balance billing
Beneficiary
Benefit
Benefit Maximum
Benefit Period
Biometric Screenings
Board certified
Brand-name drug
Broker
Capitation
Captive Insurance
Carrier
Case Management
Case mix index
Certificate Holder
Certificate of Insurance
Certificate of Need (CON)
Charity care
Children’s Health Insurance Program (CHIP)
Chronic Condition
Chronic Disease Management
Claim
COBRA
Co-insurance
Community benefit
Community rating
Conditionally Renewable
Coordination of Benefits (COB)
Co-payment (co-insurance)
Coverage
Covered Services
Credentialing
Credit for Prior Coverage
Critical access hospital (CAH)
Deductible
Denial of Claim
Dependent Worker
Dependents
Diagnostic related group (DRG)
Disability Medical Assistance
Discharge planning
Disproportionate share hospital (DSH)
Diversion
Effective Date
Enrollment Period
Exclusion
Experience rating
Experimental
Explanation of Benefits (EOB)
Federal poverty guidelines (FPL)
Federally Eligible Individual (FEI)
Fee for Service
Fee schedule
Free Look
Gatekeeper
General practitioner
Generic Drug
Grace Period
Group Insurance
Group model HMO
Guaranteed Renewable
Guaranty Issue
Health Advocacy Services
Health Care Decision Counseling
Health Coaching
Health Insurance Portability and Accountability Act (HIPAA)
Health Insuring Corporation (HIC)
Health Maintenance Organizations (HMOs)
Health Risk Assessment (HRA)
Health Savings Account (HSA)
Home health agency
Hospice
Hospital affiliation
Hospital Care Assurance Program (HCAP)
Hospital Indemnity Policy
Indemnity Health Plan
Independent Practice Associations (IPAs)
Indigent medical care
Individual Health Insurance
In-Network
Inpatient
Insured
Intermediary organization (IO)
Intermediate care facility
Lifestyle Behavioral Change Programs
Lifetime Maximum
Limitations
Limited-service, physician-owned hospital
Living will
Long term acute care hospital (LTCH or LTACH)
Long-term Care (LTC)
Long-term Care Policy
Long-term Disability Insurance
LOS
Loss
Loss Ratio
Major diagnostic category (MDC)
Malpractice
Managed Care
Maximum Dollar Limit
Medical error
Medical Savings Account (MSA)
Medically Necessary
Medicare Dependent
Medicare Part A
Medicare Part B
Medicare Part D
Medigap Insurance Policies
Morbidity
Mortality
Most-favored-nation (MFN) clause
Multiple Employer Welfare Arrangement (MEWA)//Multiple Employer Trust (MET)
Network
Nosocomial infections
Open Enrollment
Open-ended HMOs
Osteopathic
Outcome measures
Outlier
Out-of-area benefits
Out-of-Plan (Out-of-Network)
Out-of-Pocket Maximum
Out-of-State Group Policies
Outpatient
Palliative care
Participating provider
Payer
Per diem
Per member per month (PMPM)
Physician assistant (PA)
Plan Administration
Point-of-service (POS)
Pre-Admission Certification
Pre-admission Testing
Pre-certification
Pre-existing Condition
Preferred Provider Organizations (PPOs)
Prenatal care
Preventative care
Primary Care Provider (PCP)
Primary Payer
Provider
Quality assurance
Quality improvement
Rate-setting
Reasonable and Customary Fees
Reinsurance
Return on Investment (ROI)
Rider
Risk
Safety net providers
Second Opinion
Second Surgical Opinion
Secondary Payer
Self-insured Plan
Sentinel event
Short-term Disability
Short-term Medical
Specific Disease Policy
Staff model HMO
State Mandated Benefits
Stop-Loss
Subacute care
Supplemental medical insurance
Tail insurance
Teaching hospital
Tertiary care
Third-party Administrator
Triage
Triple-Option
Uncompensated care
Underinsured
Underwriting
Uninsured
Usual, Customary and Reasonable (UCR)
Utilization
Value Based Plan Design
Wage index
Waiting Period
Waiver
Well-baby care

The State of Ohio is an Equal Opportunity Employer

50 W. Town Street, Third Floor - Suite 300   Columbus, Ohio   43215
General Info: 614-644-2658  |  Consumer Hotline: 800-686-1526  |  Fraud Hotline: 800-686-1527  |  OSHIIP Hotline: 800-686-1578