Numerical or alphanumeric identifier of any special insurance policy benefits. Sometimes coverage codes appear on a patient’s insurance identification card.
Insurance Encyclopedia
Coverage decision
Determination by a health plan or insurance company whether to pay for or provide a medical service for specific clinical manifestations.
Coverage decision memorandum
See: national coverage analyses (NCA) decision memorandum.
Coverage effective date
Month, day, and year on which a group’s or individual’s health insurance coverage starts. Also called enrollment date.
Coverage form
One of the primary standardized insurance forms used to construct an insurance contract. The coverage form generally contains the insuring agreement, coverage conditions, exclusions, and policy definitions.
Coverage gap
Under a Medicare Part D plan, the step in which the patient pays all of the expenses for eligible drugs, until he or she has spent $3850. This step is sometimes referred to as the doughnut hole, also spelled donut hole.
Coverage Issues Manual (CIM)
See: National Coverage Determinations Manual (NCDM).
Coverage Part
Portion of an Insurance Policy which contain all provisions peculiar to the protection which that coverage part provides. When attached to a Policy “Jacket” containing provisions common to all coverage, the coverage part and the jacket together constitute an Insurance Policy.
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Any of the parts of commercial coverage that may be included with a commercial contract. These may be issued as a policy or attached to part of a policy.
Coverage sequence
Illness or injury described in a health insurance plan that may limit insurance coverage on a procedure.
Coverage trigger
In liability insurance, the trigger is the event that brings coverage into play. It may be either an occurrence of bodily injury or property damage or, in a form with a claims-made trigger, the formal making of a claim.
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A mechanism that determines whether a policy covers a particular claim for loss. For example, the difference between the coverage triggers of liability “occurrence” forms and “claims made” forms is that loss must occur during the policy period in the first case and claim must be made during the policy period in the second case.