Monday, March 24
Gatekeeper
A colloquial term for a primary care physician who is responsible for coordinating patient care and referring the patient to specialists. Many insurance programs, particularly HMOs, require a referral from a "gatekeeper" before covering visits to specialists.
Friday, March 21
Malpractice
Malpractice occurs when a professional is negligent or incompetent and their actions are careless, wrong or illegal. Medical malpractice is when a medical professional is negligent.
Thursday, March 20
Early Retiree
An “early retiree” is anyone who retires prior to what is considered the normal retirement age. This is often used to describe retired individuals under 65 years of age. The ACA’s reinsurance program for early retiree defines eligible retirees as between 55 and 65 years of age.
Wednesday, March 19
Hospice
Care for the terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient and outpatient services and services for the terminally ill person's family.
Tuesday, March 18
COBRA
Consolidated Omnibus Budget Reconciliation Act of 1985. Through this act employees are able to continue their employer-sponsored coverage for up to 18 months if they lose their job. The original legislation required individuals to pay full premiums to continue their coverage through COBRA. A temporary subsidy of 65% of the premium cost for the purchase of COBRA coverage for individuals who have lost their jobs between September 1, 2008 and December 31, 2009 was provided through The American Recovery and Reinvestment Act (ARRA).
Monday, March 17
Carve-out
Treatments or services that are received outside of scope of an insurance policy; these are usually reimbursed at a different rate.
Friday, March 14
Medicare Part A
Section of Medicare that includes medically necessary hospital, skilled nursing facility, home health and hospice care.
Wednesday, March 12
Network
A collection of heath care providers affiliated with an insurer. Care received from these providers is called in-network care, and care received from a non-network provider is called out-of-network care.
Tuesday, March 11
Evidence of Insurability
Forms required by many insurance providers that proves an applicant meets requirements for insurance.