The organization (such as an employer) that contracts for participation in a health insurance plan.

Used to describe the total number of enrollee in a health plan. It may also be used to refer to the process of enrolling people in a health plan.

The amount of time an employee has to sign up for a contributory health plan.

The medical examination of an applicant for Health Insurance.

The estimated claims for a person or group for a contract year based usually on actuarial statistics.

The expected incidence of sickness or injury within a given group during a given period of time as shown on a morbidity table.

Any health care services, supplies, procedures, therapies or devices that the health plan determines regarding coverage for a particular case to be either (i) not proven by scientific evidence to be effective, or (ii) not accepted by health care professionals as being effective.

The statement sent to a participant in a health plan listing services, amounts paid by the plan, and total amount billed to the patient.

A facility such as a nursing home which is licensed to provide 24 hour nursing care service in accordance with Government laws. Three levels of care may be provided – skilled, intermediate, custodial, or any combination.

A provision in certain tailor made Group Health Policies to allow the insured person to receive benefits for specified losses sustained after the termination of coverage, such a maternity expenses benefit incurred for a pregnancy in progress at the time of the termination.