Spouse and dependents of an active member of the United States government military services (e.g., Army, Navy, Air Force, Marines, Coast Guard). This phrase is used more frequently in the TRICARE health care program.

Active member of the United States government military services (e.g., Army, Navy, Air Force, Marines, Coast Guard).

Rider in a group insurance contract that states if an employee is absent from work due to illness, injury, or other specific reasons, on the date the employee’s coverage is due to begin, then insurance will not begin until the date the employee returns to work. For a dependent, a plan may require that, if in the hospital on the effective date, that date is deferred until the dependent’s release from the hospital.

Prescription drug program phrase that means the actual cost of a drug to the pharmacy or to the managed care plan that contracts with the pharmacist.

1. Fee the physician charges for service or supplier bills for a supply item at the time the insurance claim is submitted to the insurance company or government payer. 2. In the Medicare program, the fee is often more than the amount Medicare approves. See approved charge and assignment.
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The actual amount charged by a Medical Practitioner for medical services rendered.

Difference between the summarized income rate and the summarized cost rate over a given valuation period.

Method of calculating the annual amount a plan sponsor must contribute to fund a specific set of defined benefit pension plan (DBPP) benefits for a group of participants.

Negative actuarial balance.

Section in a life and health insurance company that oversees the company and is operated on a mathematically sound basis. This department calculates premium and dividend rates, establishes a company’s reserve liabilities, and figures nonforfeiture, surrender, and loan values. Its research predicts mortality and morbidity rates, and this helps sets the guidelines for selecting risks and establishes the profits of the company’s products.

One-half the expected monthly cost of the supplemental medical insurance (SMI) program for each aged enrollee (for the aged actuarial rate) and one-half the expected monthly cost for each disabled enrollee (for the disabled actuarial rate) for the duration the rate is in effect.