Agent who runs a brokerage that specializes in locating coverage for substandard cases or sells products of several insurers that underwrite substandard risks.

Insurance premium charged for an insured that is classified as a greater than average possibility of loss, usually a higher rate than a standard premium rate.

Insured classification of individuals whose physical conditions are less than standard or who have a dangerous occupation or hobby. An additional premium is required because of the likelihood of loss from an impairment.

Medical condition that coexists with the primary cause for hospitalization (principal diagnosis) and affects the patient’s treatment and length of stay by at least 1 day in approximately 75% of the cases.

Condition that occurs during the hospitalization and prolongs the length of stay by at least 1 day in approximately 75% of the cases.

Incentive arrangement that places the physician or physician group at risk for amounts beyond the risk threshold, if the risk is based on the use or costs of referral services. The risk threshold is 25%. However, if the patient panel is greater than 25,000 patients, then the physician group is not considered to be at substantial financial risk because the risk is spread over the large number of patients. Stop loss and beneficiary surveys would not be required.

1. In the ICD-9-CM diagnostic code book, words or phrases that appear under a main term and identify site, type, or etiology for diseases, conditions, or injuries. 2. See modifying terms.

Act of removing an overlying structure to better visualize the structure being examined (i.e., imposing one x-ray on top of another).

Individual chosen to be the owner of the life insurance policy if the owner dies before the person insured by the policy dies.