Type of retirement plan used for small groups and administered by trustees who are authorized to buy individual level premium policies or annuity contracts for each member of the plan. Usually the policies offer life insurance and retirement benefits.

Infrequently seen state program in which physicians accept all patients but refuse to accept reimbursement from any third party, private or government. The provider directly bills the patient and the patient applies to the insurance company for reimbursement.

Tax-deferred monies set aside for retirement in an approved account that allows individuals to make pretax contributions. Contributions and investment earnings are taxable as income when paid out of the account. IRAs can be established through financial institutions such as insurance companies and stock brokerages. Also see Section 408(k) of the Internal Revenue Code .

Situation when a member of a group of a managed care plan incurs insurance claims in excess of a certain dollar limit during the contract period and this excess it not charged against the group’s experience. Also see stop loss .

Under the Health Insurance Portability and Accountability Act (HIPAA), data that comprises a subset of health information including demographic information collected from an individual and created or received by a health care provider, health plan, employer, or health care clearinghouse. It relates to past, present, or future physical or mental health or condition of an individual and it identifies the individual.

Unforeseen, unintended event that takes place at the worker’s job site. Also known as workers’ compensation injury .
***
Social security case law definition: an accident arising while he is doing what his contract obliges him to do, and because of the risk created by what his contract obliges him to do. The accident must therefore be one which happens while he is within what has been called the scope or ambit of his work. An electrician injured while driving to work was held not to have had an industrial accident. An employee who has suffered an industrial injury does not have to satisfy the national insurance contributions for statutory sick pay and benefits.

Office that administers and governs workers’ compensation regulations in each state.