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A&H, A&S.
Accident and Health Insurance, Accident and Sickness Insurance
Generic term for the
field of Health Insurance
Accelerated Benefits
Life insurance riders
allowing the policy's death benefits to offset expenses incurred in a
convalescent or nursing home facility
Access
Availability of medical
care. Determined by availability of transportation, location, type of
medical services in the area, etc.
Accident and Health
Insurance (also referred to as A&H)
Another, older name for
Health Insurance.
Accident and Sickness
Insurance (also referred to as A&S)
Another, older term for Health Insurance.
Accident Insurance
Insurance against loss
by accidental bodily injury to the insured.
Accidental Death and
Dismemberment
(also referred to AD & D)
Policy or provision in Disability Income policy that pays
a specified amount or a multiple of the weekly disability benefit should
the insured die, lose his sight, or lose two limbs as the result of an accident.
Lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.
Accidental
Death Benefit
Extra benefit that, in
general, equals the face of the contract or principal sum, payable in addition
to other benefits in the event of death as the result of an accident.
Accidental
Death Insurance
Form of insurance providing payment if the death of the insured
results from an accident. Often combined with Dismemberment Insurance in
a form called Accidental Death and Dismemberment.
Accrete
Medicare term meaning the process of adding new members to
a health plan.
Actively-at-work
Depending upon the policy, if an employee is not actively
at work on the day the policy goes into effect, coverage does not begin
until the employee returns to work.
Activities of Daily Living
Activities performed by individuals without assistance in
the course of day to day living that include mobility, dressing, personal
hygiene and eating.
Activities of Daily Living Standards
Standards assessing the ability of an individual to live
independently, measuring the ability to perform unaided such activities
as eating, bathing, toiletry, dressing, and walking. Standards are often
discussed as a measurement or definition of eligibility for long term care.
Actual Charge
Actual amount charged by a physician for medical services.
Acute Care
Medically necessary, skilled care provided by nursing and
medical personnel to restore a person to good health.
Additional Drug Benefit List
Prescription drugs listed as commonly prescribed for patients'
long-term use. Subject to review and revision by the health plan involved.
Also referred to as drug maintenance list.
Additional Monthly Benefit
Riders added to disability income policies to providing additional
benefits for the first year of a claim while the insured is waiting for
commencement of Social Security benefits.
Adjusted Average Per Capita Cost (AAPCC)
Estimated average cost of Medicare benefits established on
county basis. Factors include age, sex, Medicaid, institutional status,
disability, and end stage renal disease status. Determines Medicare benefits
payments to cost contractors.
Adjusted Community Rating (ACR)
Community rating adjusted by factors that are specific to
a particular group. Also referred to as factored rating.
Admissions/1,000
Number of hospital admissions for each 1,000 members of plan
Admits
Number of admissions to a hospital (includes outpatient and
inpatient facilities).
Adult Day Care
Group program for functionally impaired adults. Meets
health, social and functional needs in a setting other than adult's home.
Aftercare
Patient services, customized to the individual, required
after hospitalization or rehabilitation.
Age Change
For insurance purposes, date that a person's age changes.
In majority of Life Insurance contracts, defined as the date midway
between the insured's natural birth dates. For Health Insurance purposes,
the age of the previous birth date is frequently used for rate determinations.
Based upon the rating structure of the particular insurer, on the date of
age change, a person's age may change to that of the last birth date, the
nearer birth date, or the next birth date.
Age/Sex Factor
A measurement is used in underwriting; comparing the age
and sex risk of medical costs of one group in relation to another. Higher
than average risk of medical costs due to that factor is indicated by age/sex
factor above 1.00. Conversely, a factor below 1.00 indicates lower than
average risk.
Ancillary Service
Services other than
hospital room and board, nursing, and physician services. (e.g. lab and
x-ray work)
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