Access

The availability of medical care to the patient. It is determined by locality, transportation, and type of medical services in the area.

Accident/Injury

Bodily injury to the insured person resulting directly from an accident and independent of all other causes which occurs while the policy is in force and which is an injury covered by the policy.

Accident Insurance

A form of insurance against loss by accidental bodily injury to the insured.

Accidental Death and Dismemberment

A policy or a provision in a policy which pays a specified amount if the insured dies, loses his or her sight, or loses two limbs as the result of an accident. A lesser amount is payable for the loss of one eye, arm, leg, hand, or foot.

Actual Charge

The actual amount charged by a physician or hospital for medical services provided.

Acute Illness

Medical condition that is curable within a reasonable time.

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Aftercare

Individualized patient services required after hospitalization or rehabilitation.

Age Change

The date on which a person's age changes (for insurance purposes). Health insurers frequently use the age of the previous birth date for rate determinations. 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.

Agent

Insurance is sold by two types of agents: independent agents, who are self-employed, represent several insurance companies and are paid on commission; and exclusive or captive agents, who represent only one insurance company and are either salaried or work on commission. Insurance companies that use exclusive or captive agents are called direct writers.

Allocated Benefits

Payments authorized for specific purposes with a maximum specified for each

Allowable Charge

The lesser of the actual charge, the customary charge, and the prevailing charge.

Allowable Costs

Charges which are covered expenses.

AM Best Rating

The A.M. Best Company, is the most authoritative source of Insurance company information. The company provides comprehensive data to insurance professionals. Best is the world's oldest source of insurance company ratings and information. Its Best's Ratings are the industry's standard measure of insurer financial performance.

Ambulatory Care

Care which does not require hospitalization.

Ambulatory Setting

Institutions such as surgery centers, clinics, or other outpatient facilities which provide health care on an outpatient basis.

Ancillary

Additional services such as X-rays, anesthesia, lab work, etc.

Annual Travel Insurance

If you are a frequent traveler or a business traveler, this may be the plan for you. You pay an annual fee and are covered for twelve months, regardless of the number of trips you take.

Approved Health Care Facility or Program

A facility or program which has been approved by a health care plan as described in the contract.

Applicant

The person, group, company or institution named on the application form and the medical questionnaire requesting insurance coverage.

Assignment of Benefits

A method where the person receiving the medical benefits assigns the payment of those benefits to a physician or hospital.