1. Geographical area defined by a managed care plan such as a health maintenance organization (HMO) as the locale in which it will provide health care services to its members directly through its own resources or through arrangements with other providers in the area. Members may be disenrolled if they move out of the plan’s service area. 2. Area where a Medicare private fee-for-service plan accepts members.

Program (e.g., TRICARE) that provides benefits without a contract guaranteeing the indemnification of an insured party against a specific loss; there are no premiums.

Health insurance coverage and/or medical and surgical services without cost limitations to the insured.

Organization that offers data processing of insurance claims and time-sharing services for hospital facilities and physicians.

General description of the types of service provided under the service and/or characteristics that define the service category.

1. Month, day, and year a patient receives a medical service. Dates of service are inserted in Block 24A Lines 1 through 6 of the CMS-1500 insurance claim form. Service date is inserted in Field 45 of the Uniform Bill (UB-04) inpatient hospital billing claim form. The electronic version requires an eight-character date listing year, month, and day: 20XX0328. 2. For health insurance, the effective date of membership. 3. For employment, the effective date of full-time employment.

Special dollar amount given to insurance consultants or brokers who may perform many functions of group representatives or home offices. This occurs when commissions paid to the servicing agent have ceased.

1. Health insurance plan that directly contracts with providers such as Blue Cross and Blue Shield. The providers directly bill the plan and the plan pays directly to the providers. The providers agree to certain fees and payment in full with no balance billing to the patient. The patient (member or insured) is responsible for the deductible and copayments. 2. Written document that outlines the types and frequency of long-term care services that a client receives. It may include treatment goals for a specified time period. 3. See plan of treatment .
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Insurance coverage that has contracts with providers and in which health care benefits are given to individuals instead of monetary payment. Sometimes a Blue Cross and Blue Shield plan may be referred to as a service plan .

Any individual who gives medical services or conducts a medical procedure.