EASY
covered services under terms of a member's insurance policy.
Benefits
Sercive provided under a medical plan due to a known condition or family history.
Diagnostic
The knowledge repository for the customer service team. It was created as a resource for CSRs to house guidelines, mandates, forms, contact information, and links to other websites
Knowledge Center
health care services or supplies needed to diagnose or treat an illness, injury,condition,disease or its symptoms and that meet accepted standards of medicine
Medical Necessary
he specific requirements—such as age, income, employment status, residency, or open enrollment periods—that an individual must meet in order to qualify for and enroll in a particular health insurance plan or government program (like Medicaid or Medicare).
Eligibility
The evaluation or review of the nature, quality, ability and other components of someone or something.
Assessment
This refers to services rendered while the patient was staying overnight at the hospital or other inpatient facility.
Inpatient
The process of returning an insurance's remains back to the US when an injury or sickness results in that person's loss of life while traveling outside the US. This is not an eligible benefit through Independence.
Repatriation
a cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. these caps are sometimes placed on a particular services.
Annual Limit
A core set of medical service categories that every Affordable Care Act (ACA) compliant health insurance plan must cover. These include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health services, prescription drugs
Essential health benefits
A person licensed to sell insurance to individuals
Broker
Support from People who have been through similar situations and have since successfully maintained a healthy lifestyle.
Peer Support
A Blue Cross program that provides low-cost health insurance for low income people.
Special Care
durable medical equipment includes , but not limited to, the following: hospitals beds, crutches, canes, wheelchairs, walkers, peripheral circulatory aids , cervical collars. traction equipment
Durable Medical Equipment
A distinct segment of an insurance company's operations categorized by the type of customer or market it serves, such as Individual/Family plans, Employer-Sponsored (Group) plans, Medicare, or Medicaid.
Line of business:
A set of members under a common plan. Ther premiums or monthly payments are fully or partially funded by an employer.
Group
An amendment, add-on, or retraction to the core benefits of an insurance policy.
Rider
A type of insurance to help offset the cost of medical care when traveling or living abroad. Get more information on travel insurance.
Travel insurance
This may also be called preapproval or pre-authorization. it means you may need extra approval from your health insurance plan before you receive certain test, procedures or medications.
Precertification
A health problem—such as diabetes, asthma, or cancer—that existed and was diagnosed or treated before a person enrolled in a new health insurance policy. Under the ACA, health insurers are legally prohibited from denying coverage, excluding benefits, or charging higher premiums based on preexisting conditions.
Preexisting condition
A percentage of the service fee that is the member's responsibility
Coinsurance
The process of slowly decreasing the amount of the medication being taken.
Tapering
A type of insurance to help offset the cost of eyecare, such as routine eye checkups, glass and contacts. Sometimes vision coverage is included with your medical plan, and sometimes you may need to purchase a standalone plan.
Vision insurance
Also called virtual care or an online consultation with a healthcare professional
Telemedicine
The classification system used for health plans on the ACA insurance marketplace (Bronze, Silver, Gold, and Platinum). These levels determine how you and the insurance company split medical costs (the actuarial value), rather than indicating the quality or amount of medical care you receive.
Metallic level