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Coverage gap

Under a Medicare Part D plan, the step in which the patient pays all of the expenses for eligible drugs, until he or she has spent $3850. This step is sometimes referred to as the doughnut hole, also spelled donut hole.

Coverage Part

Portion of an Insurance Policy which contain all provisions peculiar to the protection which that coverage part provides. When attached to a Policy “Jacket” containing provisions common to all coverage, the coverage part and the jacket together constitute an Insurance Policy.
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Any of the parts of commercial coverage that may be included with a commercial contract. These may be issued as a policy or attached to part of a policy.

Coverage trigger

In liability insurance, the trigger is the event that brings coverage into play. It may be either an occurrence of bodily injury or property damage or, in a form with a claims-made trigger, the formal making of a claim.
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A mechanism that determines whether a policy covers a particular claim for loss. For example, the difference between the coverage triggers of liability “occurrence” forms and “claims made” forms is that loss must occur during the policy period in the first case and claim must be made during the policy period in the second case.

Coverage type

Several varieties (contract types) of health insurance benefit plans exist:1. Individual coverage is a plan in which only one person has been accepted into the health plan. Maternity care and obstetrical services are included as benefits, but routine newborn services are not included.2. Family coverage is for the subscriber and the spouse who have been accepted into the health plan. Maternity care, obstetrical services, and routine newborn services may be included as benefits.3. Family coverage with dependents is a plan that covers maternity care, obstetrical services, and routine newborn services to the subscriber but not to the children.4. Family coverage is a plan in which the subscriber, spouse, and subscriber’s or spouse’s enrolled dependents who are his or her children are in the health plan. Maternity care, obstetrical services, and routine newborn services are benefits to the subscriber or the subscriber’s spouse but not to the children.A significant other rather than spouse is a newer change to the coverage terminology. Also known as contract type.

Covered

A person covered by a pension plan is one who has fulfilled the eligibility requirements in the plan, for whom benefits have accrued, or are accruing, or who is receiving benefits under the plan.

Covered Agreements

Defined under the Dodd-Frank Act, a covered agreement is “a written bilateral agreement or multilateral agreement regarding prudential matters with respect to the business of insurance or reinsurance that—(A) is entered into between the United States and one or more foreign governments, authorities or regulatory entities; and (B) relates to the recognition of prudential matters with respect to the business of insurance or reinsurance that achieves a level of protection for insurance or reinsurance consumers that is substantially equivalent to the level of protection achieved under State insurance or reinsurance regulation.” The FIO is authorized to assist the Treasury Secretary in jointly negotiating covered agreements with the U.S. Trade Representative. To the extent that state law is determined to be inconsistent with a covered agreement, and subject to procedural requirements set forth in the Dodd-Frank Act, that law would be preempted.

Covered benefit

Medically necessary health care service or item that is included in a health insurance plan and that is paid for either partially or fully. Some medically necessary services may not be a benefit of an insurance policy (e.g., custodial care may be necessary but not covered). Also called covered services.