1. Stated set of health insurance benefits that all insurance plans are required to offer. 2. In managed care plans, package of medical services that must be provided to individuals, small businesses, and large businesses at competitive rates (e.g., preventive care, hospital and physician services, prescription medications).

Insurance claim submitted to a third-party payer that is not accompanied by unnecessary attachments.

Standard computer system used by insurance carriers and fiscal intermediaries to process Medicare insurance claims.

In statistics, standard deviation of an estimate—multiple measurements of a given value will generally group around the mean (or average) value in a normal distribution. The shape of this distribution is known as the standard error .

Model insurance plan that was designed as the minimum drug coverage required by law. It is the standard to which all offered plans are compared. Most plans offer better coverage than the minimum required.

Legislation that is uniform in all states and requires annuity and whole-life contracts to have certain minimum cash values that are not forfeited by policyholders even if a policy is canceled. A formula is given for computing the present value, cash surrender value, and paid-up annuity benefits. The model requires insurers to state clearly if an annuity has limited or no death benefits.

1. Written statement that describes the rules, actions, or conditions that direct proper treatment of patients. 2. Specific guidelines that direct medical practice and can be used to evaluate performance. Also see standards of care protocols .

Document detailing services billed and describing payment determination (paid or denied) issued to providers of the Medicare or Medicaid program. Providers that electronically transmit Medicare claims receive an electronic remittance advice (ERA). Beginning June 1, 2006, they were no longer mailed an SPR. Also known in some programs as an explanation of benefits .

Process of ending a retirement or employee-benefit plan that has enough funds to cover all benefit amounts to which the plan’s participants are entitled.