Date of Service

The date health service was provided.

Death Spiral

Potentially destructive cycle that occurs in an indemnity plan as a result of increased HMO penetration. Process occurs if indemnity plan rates continuously increase because healthier and younger employees choose HMOs, leaving less healthy individuals in experience-rated indemnity plans. Employer contribution strategies and HMO pricing techniques add to the problem.

Deductible Carryover Credit

During the last three months of calendar year, charges incurred for services can be applied the deductible for the following calendar year. Credits may be applied whether or not the prior calendar year's deductible is met.

Deferred Compensation Administrator

A company providing services under deferred compensation plan. Services include administration of self-insured plans, salary surveys, compensation planning, retirement planning, etc.

Delete

The process of taking an individual off Medicare coverage.

Dental Insurance

A Health Insurance contract that provides payment for specified dental services.

Dependent Coverage

Insurance coverage on the head of a family which is extended to his or her dependents, including only the lawful spouse and unmarried children who are not yet employed on a full-time basis. "Children" may be step, foster, and adopted, as well as natural. Certain age restrictions on children usually apply. (LI,H)

Designated Mental Health Provider

Organization hired by health plan to provide mental health and substance abuse services.

Diagnosis

Disease identification.

Diagnosis Related Groups (DRGs)

Classificaion of inpatient hospital services. Used as method of determining financing to reimburse providers for services performed.

Disability Benefits Law

State law requiring employer to provide disability benefits to covered employees for nonoccupational injuries. This is in contrast to Workers Compensation, which pays for occupational injuries. Laws are currently in effect in New York, New Jersey, Rhode Island, California, and Hawaii.

Disability Income Insurance

Form of health insurance providing periodic payments to replace income, actual or presumed loss, when sickness of injury results in the insured being unable to work.

Disability, Long-Term

See Long-Term Disability.

Disability, Permanent Partial

See Permanent Partial Disability.

Disability, Permanent Total

See Permanent Total Disability.

Disability, Short-Term

See Short-Term Disability.

Disability, Temporary Partial

See Temporary Partial Disability.

Disability, Temporary Total

See Temporary Total Disability.

Discharge Planning

Determination of the extent of patient's medical needs after discharge from a hospital or other inpatient treatment.

Dismemberment

Loss of, or loss of use of, specified members of the body resulting from accidental bodily injury.

Dismemberment Benefit

Benefits payable for various types of dismemberment. See also Accidental Death and Dismemberment and Multiple Indemnity.

Dread (or Specified) Disease Policy

Coverage, usually with a high maximum limit, for all of medical expenses as a result of diseases specified in the contract. Diseases covered are multiple sclerosis, poliomyelitis, spinal meningitis, diphtheria, and tetanus. Cancer is may be covered or added with some companies by a rider.

Drug Formulary

Schedule of prescription drugs approved for use that will be covered by the plan. These are then dispensed through participating pharmacies.

Drug Price Review (DPR)

Determination of drug price maximums. It involves determining wholesale drug prices based on the American Druggist Blue Book.

Drug Utilization Review (DUR)

Evaluation or review of the use of drugs in order to determine appropriateness of drug therapy.

Dual Choice

Federal requirement for employers having 25 or more employees and within the service area of a federally qualified HMO, paying at least minimum wage and offering a health plan to their employees, must offer HMO coverage as well as an indemnity plan.

Duplicate Coverage Inquiry (DCI)

Request to determine whether or not other coverage exists. For use in applying the coordination of benefits provisions when two or more insurance companies are involved.

Duplication of Benefits

Identical or overlapping coverage exists between two or more insurance companies or service organizations.