Health Insurance Glossary - A Terms
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
A
Actuary
An insurance professional who analyses risks and determines premium rates and other related amounts according to probabilities based on statistical information. Consumers generally do not deal directly with an actuary.
Admitting Privileges
The right granted to a doctor to admit patients into a particular hospital.
Adverse Selection
The process of singling out applicants who are higher risk than the average. Insurers are likely to charge higher premiums, refuse to insure the individual, or refuse to insure specific risks.
Advocacy
The act of pleading for or supporting an individual or group to obtain something they need or want.
Affiliation Period
The time between the date of enrollment in an HMO plan and the date coverage begins. Not all HMOs require an affiliation period, but if an affiliation period is required, the HMO cannot exclude coverage for preexisting conditions. In addition, the HMO cannot charge premiums during the affiliation period.
Agent
A representative of an insurance company who is licensed to sell insurance policies on behalf of that company. An agent may represent more than one insurance company. If an agent represents more than one insurance company, they are known as an independent agent. An independent agent is usually paid on commission. If an agent only represents one insurance company, they are known as an exclusive or captive agent. An exclusive or captive agent may be paid a salary or a commission, or a combination of the two.
Ancillary Services
Services related to a patient's care other than those provided by a physician or hospital. Ancillary services may be either diagnostic or therapeutic. Diagnostic services include laboratory tests, radiology, magnetic resonance imaging, etc. Therapeutic services include home health care, physical therapy, transplant services, etc.
Arbitration
A process of hearing and determining a resolution for a dispute by accepting a binding or non-binding decision made by an independent third party. Parties in a dispute often prefer to use arbitration rather than going to court to avoid the high costs and potential lengthy delays of a court case.
September 7, 2010
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