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Insurance/Benefits Industry Acronyms > Acronyms > Flashcards

Acronyms Flashcards

1
Q

Accident & Health or Accident & Sickness

A

Generally, means health insurance, but can also mean coverage for short term income replacement when the covered person is disabled because of an accident or illness.

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2
Q

Annual Aggregate Deductible

A

This number represents the overall limit of claims liability for the group. Beyond this point, the stop loss policy indemnifies the group at the end of the contract period. Also called the trigger point or attachment point.

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3
Q

Affordable Care Act

A

See PPACA

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4
Q

Accountable Care Organization

A

Groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

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5
Q

Adjusted Community Rating

A

The process of determining a group’s premium rate in which the carrier adjusts the standard or pure community rate premium by adding or subtracting an amount that reflects the group’s past claims experience.

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6
Q

Accidental Death & Dismemberment

A

Insurance providing a benefit if the insured person dies by accidental means or accidentally loses certain specified body parts (leg, arm, etc.).

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7
Q

American Dental Association

A

A professional association of dentists dedicated to serving the public and profession of dentistry.

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8
Q

Age Discrimination in Employment Act of 1967

A

As amended in 1978, ADEA requires employers with 200 or more employees to offer older active employees under age 70 who are eligible for Medicare (and their spouses if they are also under age 70) the same health insurance coverage that is provided to younger employees.

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9
Q

Activities of Daily Living

A

In connection with Long Term Care insurance, these activities include bathing, dressing, eating, transferring (from one place to another, such as from bed to a chair), mobility, toileting and continence.

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10
Q

Alternative Delivery System

A

An arrangement for the provision of medical or dental services in other than the traditional way (for example, licensed dentist providing treatment in a fee-for-service dental office).

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11
Q

Account Executive

A

Position at AJG responsible for establishing client strategy, leading planning/pre-renewal/marketing meetings, peer reviewing client deliverables, identifying opportunities for new business growth, and maintaining client relationships at all levels.

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12
Q

American Hospital Association

A

A professional society in the United States whose membership is composed of hospitals.

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13
Q

Acquired Immune Deficiency Syndrome

A

A serious (often fatal) disease of the immune system transmitted through blood products especially by sexual contact or contaminated needles.

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14
Q

Average Length of Stay (hospital)

A

The average number of days a patient generally stays in the hospital with a given condition.

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15
Q

American Medical Association

A

A professional association of physicians dedicated to promoting the art and science of medicine and the betterment of public health.

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16
Q

American Nurses Association

A

A professional society in the United States whose membership is composed of nurses.

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17
Q

American National Standards Institute

A

Develops and maintains voluntary industry standards with participation by both the public and private sectors for many fields including health care. One ANSI committee, X-12, is developing uniform standards for health care claims eligibility and diagnosis so that common definitions and standards will exist within the health care industry for electronic coding of information. Much paperwork and waste will be eliminated with uniform formats and electronic standards.

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18
Q

Ambulatory Patient Groups

A

An outpatient payment methodology in which patients are categorized according to the amount and type of resources used during visits. APGs help predict the average amount of resource use among patients within a given APG.

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19
Q

Attending Physician Statement

A

A statement by the Attending Physician relaying the personal health history of an individual. This can be used for both individual medical underwriting or for an eligible claims determination.

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20
Q

Administrative Services Agreement

A

An arrangement under which an insurance carrier, its subsidiary or an independent organization will handle the administration of claims, benefits, reporting and other administrative functions for a self-insured plan.

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21
Q

Administrative Services Only

A

An arrangement under which an insurance company, for a fee, processes claims and handles paperwork for a self-funded group. This frequently includes all insurance company services (actuarial services, underwriting, benefit description, etc.) except assumption of risk.

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22
Q

Average Wholesale Price

A

Commonly used in pharmacy contracting, the AWP is generally determined through reference to a common source of information. Average cost of a non-discounted item to a pharmacy provider by wholesale providers.

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23
Q

Business Associate Agreement

A

A contract required by HIPAA that addresses the use of protected health information, specifically between entities that are not hospitals or doctors.

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24
Q

Base Annual Earnings

A

Annual salary

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25
Q

Business Intelligence

A

Business Intelligence: technological methods used to transform raw data into meaningful and useful information for business analysis purposes.

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26
Q

Blues

A

Nickname for Blue Cross and/or BlueShield plans outside of California.

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27
Q

Broker of Record (Letter)

A

A written designation from a policyholder authorizing a Broker to serve as the policyholder’s representative. This is usually used by a policyholder as a means of changing brokers, and the authorization can be rescinded.

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28
Q

Business Operating Standards and Systems

A

Internal client information storage system that adheres to Mandatory Professional Standards, which all GBS staff must adhere in their daily business operations. Data Storage includes contract reviews. http://gogbs.ajgco.com/Operations/SCR/Pages/How%20To%20Sell%20BOSS.aspx

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29
Q

Benefit Point

A

Online system that details benefit plans for companies.

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30
Q

Brokerage Services Division now referred to as GGB

A

Commercial, Industrial, Institutional, Governmental, Religious, and Personal through the US. Also referred to as P&C (Property and Casualty) http://www.wikinvest.com/stock/Arthur_J._Gallag

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31
Q

Capitation

A

A rate paid, usually monthly, to a health care provider. In return, the provider agrees to deliver the health services agreed upon to any covered person.

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32
Q

Collective Bargaining Agreement

A

Negotiation between employers and a group of employees with regards to working conditions.

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33
Q

Coronary Care Unit

A

A unit of a hospital, usually part of ICU, especially designed and staffed to care for critically ill patients with heart attack or disease or following heart surgery

34
Q

Centers for Disease Control and Prevention

A

A division of the US Public Health Service that takes the lead in analyzing and fighting infectious diseases.

35
Q

Consumer Driven Health Care

A

A savings account which allows money to be put in before tax is paid on it and then to withdraw the money tax free for qualified medical expenses.

36
Q

Consumer Driven Health Plan

A

A Consumer Driven Health Plan (CDHP) is a broad term used to describe health insurance plans with a Health Savings Account (HSA) or Health Reimbursement Account (HRA) component. CDHP’s were first introduced in the 1990’s, but they have recently become one of the latest trends on the health insurance market.

37
Q

Continuing Education

A

An on-going process in the insurance industry to keep its member professionals current, updated and responsive to the many legislative, coverage and marketing changes, through the offering of courses, workshops and seminars.

38
Q

Certified Employee Benefit Specialist

A

A professional designation of the International Foundation of Employee Benefit Plans. The designation is earned by passing examinations and through business experience. The examinations include pensions, Social Security, other retirement related plans, health insurance, economics, finance, labor relations, group insurance and other employee benefit related plans.

39
Q

Comparative Effectiveness Research

A

Comparison of existing healthcare interventions to determine which work best, for whom, and under what circumstances.

40
Q

Certified Financial Planner

A

Individual who as met the education, examination, and experience requirements set by the Certified Financial Planner Board of Standards that show the person is able to manage a client’s banking, estate, insurance, investment, and tax affairs.

41
Q

Civilian Health and Medical Program of the Uniformed Services

A

A program administered by the Department of Defense, which pays for care delivered by civilian health providers to retired members, and dependents of active and retired members, of the seven uniformed services of the United States (Army, Navy, Air Force, Marine Corps, Commissioned Corps, Commissioned Corps of the Public Health Service, Coast Guard and the National Oceanic and Atmospheric Administration).

42
Q

Claim Incurred But Not Reported

A

An insurer’s estimate of costs associated with claims that have not yet been submitted for payment, based on studies of prior lags in claim submissions. Used to set claim reserves.

43
Q

Chartered Life Underwriter

A

An individual who has completed training in life insurance and personal insurance planning.

44
Q

Client Manager

A

Position at AJG responsible for supporting the Consultant/Account Executive, managing projects and meetings based on client timeline, preparing renewal/marketing presentations and disruption reports, assisting with compliance, and maintaining relationships.

45
Q

Center for Medicare and Medicaid Services

A

The federal agency in the U.S. Department of Health and Human Services (HHS) responsible for the administration of Medicaid, Medicare, and CHIP (formerly the Health Care Financing Administration.

46
Q

Coordination of Benefits

A

Employees and their dependents should not make a profit from being insured under more than one group insurance policy. To prevent this from happening, most group insurance policies include a coordination of benefits provision. The coordination of benefits provision under a plan allows for coordinating benefits with any other group insurance payments. When all benefits are added together, no more than 100% of the covered expenses are paid.

47
Q

Consolidated Omnibus Budget Reconciliation Act

A

The act outlines continuation of coverage provisions where an employee can continue insurance coverage for up to 18 months (30 months for dependents in the event of the employee’s death) even though employment has been terminated.

48
Q

Certificate of Creditable Coverage

A

A certificate from your prior health insurance carrier describing how much creditable coverage you have and stating when your prior coverage ended.

49
Q

Cost of Living Adjustment

A

Adjusts payments to inflation so that the purchasing power of disability income benefits is not eroded. This is usually accomplished by either a flat percentage increase or an increase based on the Consumer Price Index (CPI).

50
Q

Chronic Obstructive Pulmonary Disease

A

Group of respiratory disorders characterized by chronic obstruction of the airways generally affecting an older population who are/were smokers; includes chronic bronchitis and emphysema.

51
Q

Consumer Price Index

A

The CPI measures the prices of consumer goods and services and is a measure of the pace of U.S. inflation. The U.S. Department of Labor publishes the CPI every month.

52
Q

Current Procedural Terminology

A

Refers to a reference guide that provides coding for medical and surgical procedures. Claims processors often refer to a procedure code as a CUT.

53
Q

CPT Code

A

The basis for determining the costs of specific health care services and procedures. Each service procedure has a 5-figure code. The CPT Code is an industry standard for coding and billing.

54
Q

Continued Stay Review

A

A review and an initial determination by a utilization review committee, during a patient’s hospitalization, of the necessity and appropriateness of continuation of the patient’s stay at a hospital level of care; sometimes called recertification.

55
Q

Duplicate Coverage Inquiry

A

A DCI is a form submitted by a secondary carrier to the primary carrier to determine how much the primary carrier paid for a claim so that the secondary carrier can determine how much it owes.

56
Q

Document Creation Network (DCN)

A

An AJG Corporate department resource for document creation support. http://gogbs.ajgco.com/Operations/SCR/Documents/EmployeeManual_Jan2013_FinalCombined.pd

57
Q

Deficit Reduction Act of 1984 (DEFRA)

A

Helps prevent discrimination against elderly employees in health insurance, particularly in regard to extending the provisions of TEFRA. It requires group health plans to be offered to employees’ dependents in the 65-69 age bracket, even if the employees are not in that age bracket.

58
Q

Department of Human and Health Services (DHHS)

A

A cabinet -level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services

59
Q

Dental Health Maintenance Organization (DHMO)

A

Typically, the least expensive of dental plans. All dental services are provided by professional dentists who agree to provide specific treatments and services to patients at no charge (some services may require a co-payment). DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.

60
Q

1) Double Indemnity
2) Disability Income
(DI)

A

1) A provision in certain life insurance policies (also known as an accidental death benefit) that pays double the death benefit to your beneficiary if you should die in an accident or in another way as specified by your policy.
2) A health insurance policy that provides payments in the event the insured is unable to work due to illness, sickness or accident.

61
Q

Disease Management

A

The integrated monitoring of a patient, particularly with a chronic illness, to focus on prevention of recurrence, improved quality of life, and cost-effective care. Also refers to the systematic study of a diagnosis or intervention to focus on the outcomes for a population, rather then an individual patient.

62
Q

Durable Medical Equipment (DME)

A

Items of medical equipment owned or rented which are placed in the home of an insured to facilitate treatment and/or rehabilitation. DME generally consists of items which can withstand repeated use. DME is primarily and customarily used to serve a medical purpose and is usually not useful to a person in the absence of illness or injury.

63
Q

DOB

A

Date of Birth

64
Q

DOD

A

Date of Death

65
Q

DOH

A

Date of Hire

66
Q

DOI

A

Department of insurance

67
Q

DOL

A

Department of labor

68
Q

DOT

A

Date of Termination

69
Q

Drug Price Review (DPR)

A

Updates the average wholesale price (AWP) of prescription drugs from the American Druggist Blue Book.

70
Q

DR

A

Direct Reimbursement; In-house dental plan

71
Q

Diagnostic Related Group (DRG)

A

A prospective payment system that pays a set amount for a given diagnosis. If treatment actually costs less, the provider keeps the excess; if treatment costs more, the provider loses.

72
Q

Declined to Quote (DTQ)

A

When a carrier is not interested to bid on a group (client/prospect).

73
Q

DXL / DX&L

A

Diagnostic X-ray and Laboratory

74
Q

Errors and omissions (E&O)

A

Potential Financial losses that result from negligent acts of mistakes. In the event that an error occurs, immediate evaluation and assessment by the appropriate corporate departments is critical in the mitigation of a potential claim. If an error is discovered, it must be reported to the branch manager immediately so that it can be reported through the appropriate systems. The course of corrective action to the error begins when an E&O incident report is filed via SharePoint. http://go.ajgco.com/apps/EandO/SitePages/Home.aspx

75
Q

Earnings Before Interest Taxes Depreciation and Amortization (EBITA)

A

Net income with interest, taxes, depreciation, and amortization added back to it, and may be used to analyze and compare profitability between companies and industries because it eliminates the effects of financing and accounting decisions.

76
Q

Employee Assistance Program (EAP)

A

A service, plan or set of benefits which are designed for personal or family problems, including mental health, substance abuse, gambling addiction, marital problems, parenting problems, emotional problems or financial pressures. This is usually a service provided by an employer to the employees, designed to assist employees in getting help for these problems so that they may remain on the job. EAP began with a primary drug and alcohol focus with an emphasis on rehabilitating valued employees rather than terminating them for their substance problems. It is sometimes implemented with a disciplinary program which requires that the impaired employee participate in EAP in order to retain employment. With the advent of managed care, EAP has sometimes evolved to include case management, utilization review and gatekeeping functions for the psychiatric and substance abuse health benefits.

77
Q

Extended Care Facility (ECF)

A

Facility, such as a nursing home, which is licensed to provide 24 hour nursing care service in accordance with state and local laws. Three levels of care are defined as: skilled, intermediate, custodial or any combination.

78
Q

Education, Development, Guidance, Excellence (EDGE)

A

A structured, 12 month learning and development program that provides new Gallagher associates with a solid foundation of industry knowledge so that they can build a successful, dynamic career. (http://careers.ajg.com/students-recent-graduates/training)

79
Q

Electronic Data Interchange (EDP)

A

Data processing by means of high-speed electronic equipment.

80
Q

Electronic Data Interchange (EDI)

A

In the health insurance industry, EDI is the electronic transfer of claims data from the healthcare provider to the insurer and the electronic transfer of payment from the insurer to the healthcare provider.

Insurance/Benefits Industry Acronyms (1 decks)

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