Phrase used by insurance companies and managed care companies that refers to the types of insurance plans they offer; also used as a synonym for benefits .

Health care service explained in detail that the insurance company agrees to pay to a claimant, assignee, or beneficiary under a health insurance policy or contract.

Under a group insurance plan, a table that lists the amount of coverage given to each class of insured and may show earnings and job position. Also known as benefit payment schedule, schedule of benefits, table of allowances, fee schedule, fee allowance, fee maximum , or capped fee .

Official document from the Social Security Administration that provides information on how much an individual receives in monthly Social Security benefits and/or Supplemental Security Income payments. A letter is normally issued after a request from a beneficiary or his or her authorized representative.

Time period that must elapse before health insurance benefits are payable.

Twelve-month period used by employers for administration of health benefits. Most employers’ benefit year is from January through December. However, a benefit year does not always coincide with a group’s fiscal year. See benefit period .

Scope, terms, and conditions of coverage including any limitations associated with the plan provision of the service. Also called benefits plan and benefit package .

Medi-Cal identification card.

Federal legislation that made the Medicare appeals process easier to negotiate with clearly defined levels that address reasons for rejection based on complexity of the situation. Terminology for these levels is called “redetermination” or “reconsideration” and is no longer known as an appeal.