List of a health insurance plan’s categories for eligible individuals and their dependents.

Situation that indicates a deteriorating financial condition of a retirement plan that needs to be reported to the Pension Benefit Guaranty Corporation (PBGC).

Health plan benefit that is planned, has been reported to the insurance company, but has not yet occurred (e.g., scheduled surgery).

Written statements by an individual applying for insurance about health history, family health history, occupation, and other personal information that must be substantially correct. Such representations are fraud only if they pertain to an insurance risk and were made with the intent to deceive.

Individual appointed to represent someone who receives Social Security or Supplemental Security Income (SSI) and cannot handle his or her own financial affairs. A representative payee is required to maintain complete accounting records and periodically provide reports to Social Security.

In a workers’ compensation case, an injured worker who is represented by an attorney.

Formal request submitted for processing at the beginning of a 60-day home health episode after a physician evaluates a Medicare beneficiary’s condition and assigns him or her to a case-mix group. The RAP payment is the first of the two payments required during an episode under the home health prospective payment system.

Entity who formally requests access to the Centers for Medicare and Medicaid Services (CMS) data.

Under the Health Insurance Portability and Accountability Act (HIPAA), mandate contained in law that compels a covered entity to make use or disclosure of protected health information and that is enforceable in a court of law such as court orders and subpoenas.