Medical treatment provided for a certain diagnosis (i.e., carrying out the procedure, other ancillary elements, and normal follow-up care related to the medical problem).

Act of replacing one drug in a therapeutic class for another drug in the same category of drugs but with a different chemical ingredient. It is expected to have similar beneficial effects. Also see generic substitution .

Treatment of disease or injury of a patient seeking to relieve symptoms or produce a cure.

Health care treatment of any illness or injury to encourage the recovery of the patient (e.g., cardiac rehabilitation, kidney dialysis, occupational therapy, physical therapy, radiation therapy, respiratory therapy, shock therapy, speech therapy).

Insurance application submitted by an individual other than the person being insured.

System of marketing individual insurance to groups in which the insurance company formally agrees with an organization to sell individual insurance to members of the organization.

Insurance coverage bought by the insured (first party) from an insurance company (second party) for coverage to protect against lawsuits by another (third party).

1. Third-party liability exists if an entity (not connected with the employer) is the cause and is liable to pay the medical cost for injury, disease, or disability of a person hurt during the performance of his or her occupation and the injury is caused by an entity not connected with the employer. 2. Entity that is responsible for the cost of an illness or injury (e.g., automobile, homeowner insurer). Also referred to as third-party payer liable .

Private insurance company or government fiscal intermediary (third party) that insures and/or pays provider (second party) for health care benefits of members or beneficiaries (first parties) (e.g., Blue Cross, Medicare, Medicaid, commercial insurance companies). Also known as indirect payer, insurance company, insurer , or payer .

Private insurance company or government fiscal intermediary (third party) legally responsible under a contract to pay providers who rendered health care benefits to its members or beneficiaries.