Glossary Health Insurance T to V

Glossary Health Insurance

You will find an expanded list and definition of terms in this glossary health insurance T to V section.

Use it often, especially when you begin to review your health insurance policy and benefits.




T

Temporary Assistance for Needy Families (TANF): A program that seeks to provide cash benefits to lower income families with children. If you qualify for TANF, then you generally also qualify for Medicaid.

third-party administrator (TPA): An outside person or firm which provides specific administrative duties (including premium accounting, claims review and payment, arranges for utilization review and stop-loss coverage) for a self-funded plan.

third-party payer: Any payer for health care services other than the insured. This can be an insurance company, an HMO, a PPO, or the Federal Government.

trend factors: The percentage of increase used by an actuary to reflect the projected rise in health care costs overall. Calculation factors include inflation, utilization, technology and geographic area.


U

uninsurables: High-risk uninsured persons whose medical condition(s) precludes them from buying health insurance.

urgent care: Immediate care given to address a medical emergency that has not yet reached the level of extreme emergency. Most managed care plans require you to seek urgent care at a participating urgent care facility or hospital.

usual, reasonable, and customary: The amount that is considered the normal payment range for a specific medical procedure performed within a given geographic area. Your health insurance company may not allow the full amount charged to you, if it is higher than what is considered normal for the covered health care services.


V

vision care coverage: A type of specified expense coverage that provides benefits for expenses you incur in obtaining eye examinations and corrective lenses.

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