Amount of credit given to a group’s actual insurance claims experience in establishing a projection of future claims or in calculating a dividend. Also called credibility factor.

1. From the Latin credere, meaning “to believe” or “to trust”; trust in regard to financial obligation. 2. Accounting; entry reflecting payment by a debtor (patient) of a sum received on his or her account.

1. Any previous health insurance coverage that can be used to shorten the preexisting condition waiting period. See also preexisting condition. 2. Under a Medicare Part D plan, a prescription drug coverage from another private insurance plan (Medigap and employer plans) that meets certain Medicare standards. When a patient is enrolled in a drug plan that gives prescription drug coverage, the plan tells the patient that coverage is equal to or better than the standard model and it is considered creditable coverage. Also called creditable prescription drug coverage.

1. Person to whom money is owed either directly or indirectly. 2. Individual who offers or extends credit creating a debt or to whom a debt is owed.
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The person to whom a debt is owed.

Represent insurance underwriting factors that have a favorable effect on an individual’s mortality rating. Credits are assigned negative values.

Word used to count toward eligibility for future Social Security benefits. Individuals work and pay taxes and earn credits. A maximum of four credits can be earned each year. Most people need 40 credits to qualify for benefits. Younger people need fewer credits to qualify for disability or survivors’ benefits. Work credits were formerly called quarters of coverage.

1. Expected levels of achievement or specifications against which performance can be assessed. 2. Guidelines or standards of medical care that compare the necessity, appropriateness, or quality of medical services.

Freestanding hospital emergency department that gives limited inpatient care to stabilize a patient before discharge or transfer to an essential access community hospital (EACH) for extensive treatment. This was established as part of the Balanced Budget Act of 1997 (BBA) Medicare Rural Hospital Flexibility Program to replace the Essential Access Community and Rural Primary Care Hospital Programs.