MEDICAL,USA: 1. Section in the insurance policy stating the medical conditions that may or may not be a benefit paid by the insurance company. 2. Benefits the patient receives from an insurance plan (e.g., medical services and procedures, medical supplies). It may include surgery or medical treatment of illnesses or injuries, emergency department care, and hospital services. 3. Under a Medicare Part D plan, the prescription drug costs that are paid by the insurance plan are the patient’s benefits, or coverage. Also called covered expenses or covered services. 4. Amount of insurance an individual has.
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The extent of the insurance benefit supplied by the insurance contract.
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US: The scope of protection provided under a contract of insurance; any of several risks covered by a policy.
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The scope of protection provided under an insurance policy. In property insurance, coverage lists perils insured against, properties covered, locations covered. Individuals insured and the limits of indemnification. In life insurance, living and death benefits are listed.
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US: Used synonymously with “”insurance”” or “”protection.””
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Used synonymously with &#8220insurance&#8221 or &#8220protection.&#8221
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The extent of the insurance benefit supplied by the insurance contract.
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US: The scope of protection provided under a contract of insurance; any of several risks covered by a policy.
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The scope of protection provided under an insurance policy. In property insurance, coverage lists perils insured against, properties covered, locations covered. Individuals insured and the limits of indemnification. In life insurance, living and death benefits are listed.
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US: Used synonymously with “insurance” or “protection.”
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Used synonymously with &#8220insurance&#8221 or &#8220protection.&#8221

Abbreviated process for making changes to the coding component of the negotiated laboratory National Coverage Determinations (NCDs). The process is used for adjusting the list of covered or noncovered diagnostic codes and coding guidance in the NCDs when there is a question regarding whether the code flows from the narrative indications in the NCD. A tracking sheet is posted after opening a CAL, and a 30-day public comment period follows. A decision memorandum that announces and explains the decision is posted after the comment period. Changes are adopted in the next available quarterly update of the laboratory edit module.

Medicare+Choice plan charge schedule used to base the maximum dollar coverage or coinsurance level for a service category (e.g., a $500 annual coverage limit for a prescription drug benefit may be based on a Published Retailed Price schedule, or 20% coinsurance for durable medical equipment benefit may be based on a Medicare fee-for-service fee schedule).

Type of medical service in which insurance coverage is either fully covered, limited, restricted, or not provided in an insurance plan (e.g., dental or vision benefits).

Numerical or alphanumeric identifier of any special insurance policy benefits. Sometimes coverage codes appear on a patient’s insurance identification card.

Determination by a health plan or insurance company whether to pay for or provide a medical service for specific clinical manifestations.

Month, day, and year on which a group’s or individual’s health insurance coverage starts. Also called enrollment date.