Defined health care charges that an insurer will consider for payment as listed in the terms of an insurance policy or contract. Also called covered services or coverage.
Insurance Encyclopedia
Covered expenses (Health Insurance)
Expenses that qualify for reimbursement or coverage under a policy.
Covered function
Under the Health Insurance Portability and Accountability Act (HIPAA), this phrase refers to the tasks (functions) of a covered entity, the performance of which makes the entity a health plan, health care provider, or health care clearinghouse.
Covered lives
Total of insured members of a managed care plan or individual or group insurance plan.
Covered loss
An accident, including accidental damages by forces of nature, that brings a contract of insurance into play. Illness, injury, death, property loss, legal liability, or any other situation or loss for which an insurance company will pay benefits under a policy when such event occurs.
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Any type of loss the insurer will pay for under a policy. This can include death, injury, property damage or loss, or automobile collision.
Covered Person
A person who pays premium into the contract for the benefits provided and who also meets eligibility requirements.
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Any person covered under an insurance contract.
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MEDICAL,USA: Individual who is an insured, enrolled participant, member, or enrolled dependent entitled to benefits under a health insurance policy or managed care plan; also referred to as policyholder, subscriber, or employee.
Covered services
1. Specific health care services and supplies for which the insurance plan or federal or state program will provide reimbursement for covered persons under the terms of the plan; these consist of a combination of mandatory and optional services stated in each plan. 2. Services for which supplemental medical insurance (SMI) pays, as defined and limited by statute. Covered services include most physician services, care in outpatient departments of hospitals, diagnostic tests, durable medical equipment, ambulance services, and other health services that are not covered by the hospital insurance program. Also called coverage or covered expenses.
Covered worker
Person who has earnings creditable for Social Security purposes on the basis of services for wages in covered employment and/or on the basis of income from covered self-employment. The number of hospital insurance covered workers is slightly larger than the number of Old Age, Survivors, and Disability Insurance (OASDI)–covered workers because of different coverage status for federal employment.
Coverholder
A person authorised to accept or to issue insurance documents evidencing the acceptance of risks on behalf of Lloyd’s syndicates and other insurers. A coverholder has binding authority. Lloyd’s requires coverholders to comply with prescribed guidelines and undergo a monitoring and review process.