Health Insurance Terms (Starting with the A's)

Accredited (Accreditation):A "seal of approval" for health care facilities. Being accredited means that a facility has met certain quality standards. These standards are set by private, nationally recognized groups that check on the quality of care at health care facilities.

Accumulation Period:Timeframe within a policy period in which deductible and out-of-pocket amounts are calculated. For most health insurance policies, the accumulation period is a calendar year.

Administrative Services Only (ASO):An arrangement in which an employer hires a third party to deliver employee benefit administrative services to the employer. These services typically include health claims processing and billing. The employer bears the risk for health care expenses under an ASO plan.

Admitting Physician :The doctor responsible for admitting you to a hospital or other inpatient health facility.

Admitting Privileges:The right granted to a doctor to admit patients to a particular hospital

After Care:The care or follow-up treatment needed by a patient who has recently undergone surgery, been involved in an accident or has experienced an illness requiring hospitalization.

Agent of Record:The insurance agent recognized by a client to represent the client's interests in doing business with an insurance company.

Ambulatory Care:All types of health services that do not require an overnight hospital stay

Ancillary Services:Services, other than those provided by a physician or hospital, which are related to a patient’s care, such as laboratory work, x-rays and anesthesia

Any Willing Provider Laws:Legislation that requires health care plans to accept into their PPO and HMO networks any provider willing to agree to the network's terms and conditions

Appeal:Request made to a payer to reconsider a decision, such as a claim denial or denied prior authorization request. Most appeals must be submitted in writing within a specified period.

Assignment of Benefits:When an insured person assign benefits, they sign a document allowing the hospital or doctor to collect health insurance benefits directly from the health insurance company. Otherwise, the insured person pays for the treatment and is later reimbursed by the health insurance company.

Attachment:A policy modification which changes, restricts or clarifies coverage

10 part series on how to protect your car from theft

Part -1-

Park Your Car in the Garage or Behind a Locked Gate. This is your all-time best defense.
Reason: Most cars are stolen off the street or from parking areas. Putting your car into a garage not only saves the finish, but tends to deter auto thieves. They risk detection by dogs, motion sensors and even homeowners by coming on the property. Locked garages and gates create another level of difficulty for the thief who intends to quietly sneak in and steal. If you don’t lock the gate, at least put a bell or other noise-making device on it.

COVER MY COLLEGE STUDENT PLEASE!!!

Insurance for college students is overlooked during college planning. Should your household be one of 9 million with a student headed to school, find out if your child needs property insurance or renter’s insurance. Sending your child off to college is a time full of wonderand questions. In addition to all the normal questions such as, "How am I going to pay for all this?" you may be wondering whether your college student's possessions are covered by your homeowners insurance or if purchasing renter's insurance makes sense.

Everyone knows that as students move into dorm rooms and apartments for the school year, they also take with them their clothing and sports equipment, as well as cell phones, IPods and MP3 players, TVs and computers. Unfortunately, thieves know this as well, making students highly vulnerable, leaving one out of 10 college students a victim of theft. Knowing this, what's the best way to make sure your child's possessions are protected?

Most students will be covered under their parents' homeowners' insurance policy, although in some instances it will be necessary to purchase renter's insurance as well. To determine the best fit for your needs, you'll need to conduct an inventory of what your student is planning on bringing to college

Where your college student lives also makes a difference when it comes to having the right policy protection. Tell your insurance agent whether your student will be living on campus in the dormitory, or off-campus. Sometimes students who live off-campus are not covered under their parents' homeowners policy, so additional renter's insurance is necessary.

Parents should add up all the valuables a student brings to campus – netbook, smart phone, mp3 player, bike, textbooks, etc. A property inventory checklist is available to download at the National Association of Insurance Commissioners (NAIC) website. Homeowner’s insurance covers 10 percent of personal property away from home. IIAT says a policy with $100,000 worth of coverage on personal property provides $10,000 to students on campus. To be eligible, the student must be covered under the homeowner’s policy and be a legal resident of the household.

What is COBRA
What is COBRA? COBRA is the acronym for the Consolidated Omnibus Budget Reconciliation Act, a 1986 federal law that allows for the temporary extension of group health coverage to people whose health benefits otherwise would be terminated.

What does COBRA do? It allows certain employees, retirees, spouses, former spouses and dependent children to continue health insurance coverage at group rates for specifics time periods. To be eligible, a person must have been enrolled in their employer's health plan when he or she was working for that particular company.

When does that coverage take effect? COBRA becomes available when an individual covered by a group health plan loses health insurance coverage because of a "qualifying event;" e.g., when an active employee's hours are reduced or job is terminated for reasons other than a person's gross misconduct. Spouses and dependent children may become COBRA-eligible when a covered employee's job is terminated or hours are reduced; when the employee becomes eligible for Medicare; upon the employee's death; or in the event of divorce or legal separation from a covered employee.

How long does COBRA coverage last? COBRA begins on the date when a qualifying event triggers the loss of the health coverage. The law allows up to 18 months of continued coverage for certain qualifying events and up to 36 months for other qualifying events or a second qualifying event during the initial period of coverage. Employers may choose to provide coverage for longer periods if they wish.

How much will I pay? You'll pay the entire premium amount, including the portion of the premium that your employer used to contribute toward your health benefits. You may also be required to pay a 2 percent administrative fee.

Do employers have to offer COBRA? Generally speaking, group health plans maintained by private-sector employers with 20 or more workers are subject to COBRA rules. However, if a company closed or went bankrupt and no longer offers a health plan, there is no required COBRA provision.

What's the process? Employers and qualified beneficiaries must inform the health plan administrator that a qualifying event has occurred. An employer has 30 days to give that notice in the event of an employee's death, termination, reduced hours of employment or entitlement to Medicare. A qualified beneficiary has 60 days to give notice after a divorce or legal separation or when a child no longer is covered as a dependent. A notice of the qualifying event must be sent to plan participants and beneficiaries within 14 days after the plan administrator receives notice that a qualifying event has occurred. An individual has 60 days to decide whether to elect coverage. After electing coverage, the person has 45 days to pay the premium.

What are the advantages of taking COBRA? Qualified individuals are able to buy temporary health insurance coverage at the group health rate. You will, however, pay more than active employees whose coverage is subsidized by the employer.

SOURCE: U.S. Department of Labor, Washington, D.C. October 24, 2005.