Health Insurance Glossary - C Terms
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C
Calendar Year
The period beginning on January 1 and ending on December 31 of the same year.
Cancellation
The termination of insurance coverage during the policy period.
Carrier
The insurance company that underwrites and issues the insurance policy.
Case Management
The system of coordinating medical services for the most optimum, cost-effective treatment of a patient.
Certificate of Coverage
A document provided to an insured that describes the benefits, limitations and exclusions of coverage provided by the insurance company under the policy. Also known as a Certificate of Insurance.
Certificate of Creditable Coverage
A document provided to an insured as evidence of coverage under a health plan. A certificate of creditable coverage is usually provided automatically when an insured leaves a health plan.
Certificate of Insurance
A document provided to an insured that describes the benefits, limitations and exclusions of coverage provided by the insurance company under the policy. Also known as a Certificate of Coverage.
Claim
A notice to an insurer requesting payment or reimbursement of the cost of medical services provided to the insured in accordance with the terms of the policy.
Claimant
A person who makes a claim.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)
A law passed by the U.S. Congress and signed by President Reagan that allows an insured employee and their dependents to continue health insurance coverage under their employer's group health plan for up to 18 months, or 36 months for dependents in certain circumstances, if they lose their job or their coverage is otherwise terminated. The former employee must pay the full premium (including the share previously paid on their behalf by their employer) plus a 2% administrative fee.
Learn more about COBRA.
Coinsurance
The portion of a single medical bill, above the deductible and expressed in a percentage, the insured is responsible for paying. The maximum amount payable by the insured may be limited to a specified ceiling. For example, an insured may be responsible for paying 20% of the costs above the deductible, up to a maximum of $2,000.
If treatment cost $1,000 and the deductible is $100, the insured would be required to pay $280, which is the deductible of $100 plus 20% of $900 ($1,000 treatment cost less $100 deductible).
If treatment cost $15,000 and the deductible is $100, the insured would be required to pay $2,000. The deductible of $100 plus 20% of $14,900 ($15,000 treatment cost less $100 deductible) = $3,080. But $3,080 exceeds the maximum limit of $2,000; therefore the insured would only be required to pay $2,000.
Commission
Fee paid by an insurance company to an insurance broker or insurance agent. Commission is usually expressed as a percentage of the policy premium, but it may be a fixed amount. The percentage or amount varies depending on the coverage and the insurer. Because an insurance broker is paid a commission by the insurance company, the broker does not usually charge clients a fee for their services.
Continuous Coverage
Health insurance coverage that is not interrupted by a break of 63 or more consecutive days. An employer waiting period or an HMO affiliation period do not count as gaps in health insurance coverage for the purpose of determining if coverage is continuous.
Contract Period
The period of time commencing on the effective date of a contract and ending on the earlier of the expiration date or the cancellation date of the contract.
Conversion
The right of an insured to convert to an individual health plan when leaving a fully insured group health plan.
Coordination of Benefits (COB)
A contract provision that applies when someone is covered under more than one medical plan. All affected insurers must coordinate the payment for services to prevent duplication of benefits.
Copayment
A predetermined fixed fee, expressed in a dollar amount, that an insured is required to pay for certain health care services. This is usually used in relation to primary care doctor visits, specialist visits, and hospital ER visits, irrespective of the treatment or type of services provided during the visit. For example, an HMO may require a copayment of $15 for primary care doctor visits, $25 for specialist visits, and $75 for a hospital ER visit. The copayment amount normally must be paid by the insured at the time the service is rendered.
Covered Expense
An expense incurred by an insured that will be reimbursed by the insurer in whole or in part in accordance with the provisions of the health insurance plan. A covered expense may be subject to limits, such as a maximum amount or a maximum number of visits.
Credit for Prior Coverage
Something an insured may receive when they switch employers or insurance plans. This may be of considerable benefit to the insured because they may avoid a pre-existing condition waiting period before coverage commences under the new plan.
Customary Charge
September 7, 2010
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