Virginia Health Insurance Glossary

Accident and Health Policy: policy covering both injury and sickness

Blue Cross Blue Shield: prepaid plans with subscribers paying a set fee for the services of doctors at a predetermined price (Anthem Virginia - Blue Cross Blue Shield)

COBRA: employers with 20 or more employees must provide health coverage extension to all employees and dependents up to 18 months due to termination of employee or a reduction in hours. Coverage could continue for dependents up to 36 months for qualified events.

Coinsurance: the percentage the insured pays above the insurance policy's deductible until the policy's stop loss maximum has been met

Deductible: the amount of expenses that must be paid by the insured before the insurer will cover any expenses

Elimination Period: period of days that must expire after the onset of illness or occurrence of accident before benefits will be payable

Fee-for-Service: payment is made directly to the provider for medical services received

Grace Period: period of time after the premium due date before the policy lapses for nonpayment of premium. Varies with mode of premium

Health Savings Account (HSA): trust account created exclusively to pay the account holder's qualified medical expenses

High Deductible Health Plan (HDHP): health plan generally with lower premiums and a higher dedutible for major medical expenses

Health Maintenance Organization (HMO): a managed health care system providing a comprehensive array of medical services on a prepaid basis to subscribers living within a specificied geographic area and limiting the choice of providers

HIPPA: Act that helps provide coverage for people with pre-existing conditions when changing employers. The Act guarantees people who have been covered for 12 months and choose to participate in a new employer's health plan have a continuation of health benefits. HIPPA guarantees the right to coverage with no waiting period for pre-existing conditions.

Health Reimbursement Arrangement: reimburses employees for qualified medical expenses; entirely employer-funded with no limit to employer contributions

Medical Savings Account: tax-deferred deposits can be made for medical expenses; withdrawals are tax-free if used for qualified medical expenses. Must be coupled with a high deductible health plan

Out-of-Pocket Maximum: the maximum amount you must pay yearly towards medical expenses before the insurer will cover 100% of medically necessary expenses

Pre-existing Conditions: a medical condition belonging to the individual before the health plan went into effect

Preferred Provider Organization (PPO): selected group of independent hospitals and medical practitioners in a certain area that agree to provide services to subscribers at a prearranged cost 

Prepaid: provides health care in return for predetermined monthly premiums

Reinstatement: allows the insured to reinstate a policy that has lapsed for nonpayment of premium by paying past due premiums; the insurance company could require a reinstatement application to prove insurability

Right to Examine (Free Look): allows the insured a specified number of days to look over the policy with the ability to return it for a full refund

Underwriting Actions:

• issue standard-coverage issued for the rate that was quoted
• issue rated-up-issue the coverage requested but at a higher rate
• issue with exclusions or limitations-limits the insurer's obligation to pay
• rejection-policy not issued, normally because of excessive risk 

Waiting Period: specified period of time set by an employer before an employee is eligible to enroll for group benefits


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