MEDICAL,USA: 1. Contract between the policyholder and/or member and insurance carrier or government program to reimburse the policyholder and/or member for all or a portion of the cost of medically necessary medical care rendered by health care professionals. 2. General category generic term that includes many types of insurance coverage such as insurance that applies to lost income arising from illness or injury—disability income insurance, accident and health insurance, hospital confinement insurance, hospital expense insurance, surgical expense insurance, major medical insurance, dental expense insurance, accidental death and dismemberment insurance, and medical expense insurance. Insurance may be obtained on either an individual or a group basis. Also referred to as medical insurance .
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A policy that will pay specifies sums for medical expenses or treatments. Health policies can offer many options and vary in their approaches to coverage.
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Health Insurance is a way to distribute the financial risk associated with the variation of individual’s health care expenditures by pooling costs over time (Pre-payment) and over people (pooling). (OECD 2004). The Health Insurance Insurer undertake to indemnify an individual against expenses incurred due to any variation in their health. It collects an upfront contribution from an individual (commonly known as premium) and pools it over many people.
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Protection against the costs of lost income and hospital and medical care arising from illness or injury, also accidental loss of life, limb, or sight. Also called accident and sickness, accident and health, sickness and accident, or disability insurance.
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Section 2(f) of the IRDA Registration of Indian Insurance Companies Regulations 2000 defines health insurance business or health cover as “the effecting of contracts which provide sickness benefits to medical, surgical or hospital expenses benefits whether in-patient or out-patient, on an indemnity, reimbursement, service, prepaid, hospital or other plans basis, including assured benefits and long term care.

In 2003, HIAA, Group Health Association of America (GHAA), and the American Managed Care and Review Association (AMCRA) merged with American Association of Health Plans (AAHP) and created what is now known as America’s Health Insurance Plans (AHIP) . See America’s Health Insurance Plans (AHIP) .

Request for payment on behalf of the insured (patient) to an insurance company for professional services rendered by a provider.

1. Professional uniform insurance claim form developed and approved by the American Medical Association Council on Medical Service and the Centers for Medicare and Medicaid Services. The version in current use is the CMS-1500 (08-05). It is also known as the UCF-1500 . It is used by physicians and other professionals to bill outpatient services and supplies to Medicare, TRICARE, and some Medicaid programs, as well as some private insurance carriers and managed care plans. Formerly known as HCFA-1500 . 2. For electronically transmitted professional claims, the 837P replaces the paper CMS-1500 form and the electronic national standard format (NSF). 3. In Medicare fraud, altering insurance claim forms to obtain a higher payment amount.

Unique nine-digit Medicare entitlement number assigned to an individual by the Social Security Administration. It appears on the Medicare beneficiary’s identification card and is used when submitting an insurance claim to the fiscal intermediary for payment. The HICN is used with a one- or two-letter or one-letter and one-number suffix. A letter prefix may indicate that the beneficiary is entitled to railroad retirement benefits.

Under the Health Insurance Portability and Accountability Act (HIPAA), an insurance company, insurance service, or insurance organization that is licensed in the state to do business involving insurance and is subject to the state’s laws regulating insurance. This phrase does not include a group health insurance plan.

Groups of businesses that join together to lobby for better insurance policies or lower premiums from insurance companies.

Allows an individual to keep an employer-group medical insurance plan when changing jobs. See Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) .