Individual who receives life insurance proceeds that are still payable under a settlement option at the time of the primary payee’s death. Also called successor payee.

Payment to be made only if a specific predesignated condition is met.

Insurance policy provision that allows an insured to continue insurance coverage when specific conditions are fulfilled (e.g., continued full-time employment beyond age 65).

Record or schedule that shows morbidity statistics indicating the distribution of insurance claims categorized by duration of illness or amount of expense of the claims.

Insurance coverage that remains even though an employee has a termination of employment or becomes divorced. Continuation of coverage is required by and specified in the Consolidated Omnibus Reconciliation Act of 1985 (COBRA) legislation.

Managed care plan option that allows an enrollee to continue in the Medicare+Choice plan when he or she leaves the plan’s service area to reside elsewhere, possibly permanently.

Evaluation conducted by a hospital or managed care plan to determine if the current place of service is the most appropriate to give the level of care needed by the patient. Also called utilization review (UR), utilization and management control, and medical review (UR).

Self-sufficient community that provides residential services (meals, housekeeping, laundry) and housing to meet the needs of elderly individuals. There is usually a large lump-sum entrance fee and a monthly fee. CCRCs provide independent living, intermediate and skilled nursing care, personal care, and organized social and recreational activities designed for participation in community life. Licensed as nursing homes/residential care facilities or as homes for the aging.

Insurance claim submitted for the same confinement or course of ongoing treatment for which a previous initial bill has been submitted. Such claims can be submitted every 30 or 60 days.

Formal education pursued by a working professional and intended to improve or maintain professional competence by obtaining current knowledge pertinent to the individual’s specific health care career. Also called continuing medical education.