Procedures which improve the appearance, but are not medically covered.
Insurance Encyclopedia
Health Cost Containment or Control
The control or reduction of inefficiencies in the consumption, allocation, or production of health care services that contribute to higher than necessary costs.
Health Covered Expenses
Health care expenses incurred by an insured or covered person that qualify for reimbursement under the terms of a policy contract.
Health Credentialing
This involves approving a provider based on certain criteria to provide or participate in a health plan.
Health Custodial Care
Care that is primarily for meeting personal needs such as help in bathing, dressing, eating or taking medicine. It can be provided by someone without professional medical skills or training but must be according to doctor’s orders.
Health Emergency
An injury or disease which happens suddenly and require treatment within 24 hours.
Health Employer Data and Information Set (HEDIS)
Set of standard evaluation measures that gives information about the quality and performance of a health plan such as the quality of care, access, cost, patient satisfaction, membership and use, financial information, management, and other measures to compare managed care plans. Employers, health maintenance organizations, and the National Committee for Quality Assurance developed HEDIS. The Centers for Medicare and Medicaid Services (CMS) collects HEDIS data for Medicare plans.
Health Encounter
Each time a person meets with a health care provider to receive services, is a separate “encounter.”
Health Encounters Per Member Per Year
The total number of encounters per year divided by the total number of members per year.
Health Enrollee
An eligible individual who is enrolled in a health plan – does not include an eligible dependent.