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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.

Covered employment

All employment and self-employment creditable for Social Security purposes, except in a few employment situations (e.g., religious orders under a vow of poverty, foreign affiliates of American employers), or the employer must elect state and local government coverage. However, as of July 1991 coverage became mandatory for state and local employees who do not participate in a public employee retirement system. All new state and local employees have been covered by Social Security since April 1986 except ministers or self-employed members of certain religious groups who can opt out of coverage. Covered employment for hospital insurance includes all federal employees, whereas covered employment for the Old Age, Survivors, and Disability Insurance (OASDI) Program includes some, but not all, federal employees.

covered entity (CE)

1. Under the Health Insurance Portability and Accountability Act (HIPAA), this is a health plan, clearinghouse, or health provider who transmits health information and financial and administrative transactions in electronic form in connection with a HIPAA transaction. 2. From the perspective of the medical transcription service owner or independent contractor, the covered entity is the client. The CE is responsible for the protection of health information and, if there is a violation, can request documentation from its business associates to prove their compliance.