Cost of Living Adjustment Rider (COLA)

With this rider, the initial benefit doesn’t change as it does with the automatic increase rider, but the benefit increases after disability. The purpose of this rider is to keep the insured’s purchasing power even with inflation. For example, with a 3% COLA rider and an initial benefit is $5,000 per month, in year 2 the benefit would increase to $5,150 per month or by the amount of inflation if less than 3%.

Cost outlier review

Review by a professional review organization (PRO) for the necessity of a patient’s hospital admission and to determine whether all services rendered were medically necessary. Cost outlier cases are recognized only if the case is not eligible for day outlier status.

Cost plus

1. Health insurance funding in which the insurance carrier does not assume an underwriting risk. The group that is insured pays the costs of benefits (incurred claims), pays administrative costs, and contributes to the insurance carrier’s contingency reserve fund. 2. System of payment for inpatient hospitalization in which total operating costs and certain allowable capital costs are used in determining the per diem (per day) rate. When the amount of payment from a payer becomes insufficient or when uncompensated services are given, providers go to cost shifting and charge extra to the payers who do not exercise strict cost controls. This system is a typical means for providing uncompensated care to the uninsured.