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Accelerated death benefit
This rider provides early access to life insurance benefits in case of a terminal illness. Living benefits are paid to the insured for medical expenses before death. Benefits paid decrease the benefit payable to beneficiaries after the insured's death
Accepting assignment
Accepting Assignment refers to those instances when a provider agrees to accept the TRICARE allowable charge(s).
Access refers to your ability to obtain medical care.
Access fee
This is a fee you pay directly to a provider for a service related to treatment covered by your insurance provider.Some HumanaOne plans have access fees for specific services. These fees are separate from deductibles, coinsurance, or copayment charges. For example, there is an emergency room access fee that must be paid each time you visit an ER. The emergency room access fee is waived if you're admitted to the hospital.
Accidental death benefit rider
An additional cash benefit paid in addition to other benefits when a death is a result of an accident.
For spending accounts, this term refers to the particular type of account (FSA, PCA, or HSA) the subscriber participates in.
Account termination date
The date a spending account was closed.
Accumulation period
Length of time an individual has to incur covered expenses to satisfy a required deductible and/or calendar year or plan year maximum.
Actively-at-work provision
Life insurance coverage is not available to employees who are not actively at work on the effective date of the employer's contract with Humana; employees are covered when they return to work.
Actual charge
The amount of money a doctor or supplier charges for a specific medical service or supply is the actual charge. This is often higher than the approved amount that you and Medicare pay because Medicare and insurance companies negotiate lower rates for members.
Processing a claim to determine proper payment is referred to as adjudication.
This refers to your entry into a medical facility as a registered inpatient according to the rules and regulations of that facility. Your admission ends when you are discharged or released from the facility.
Admitting physician
The doctor responsible for admitting you into a hospital or other inpatient health facility is referred to as the admitting physician.
Advance coverage decision
This is a decision on whether a specific service is covered under your Private Fee-for-Service Plan.
Advanced imaging
Advanced imaging refers to radiology tests that use complex, highly developed, non-invasive technology to view the interior of the body. Examples include CT scans, ultrasound, MRA, and MRI tests.
Age in
When a retiree or eligible dependent becomes Medicare eligible — usually after turning 65 — and is eligible to enroll in the group sponsored Medicare Advantage plan.
Age limit
The minimum and maximum ages for applicants looking to enroll or renew benefits with an insurance company is also known as age limit.
Allowable charges
Allowable charges are the maximum amount a benefits plan will pay for a procedure.
Allowed amount
The allowed amount is the maximum charge allowed for a specific covered medical service or supply.
Ambulatory care
Any health service that does not require an overnight hospital stay is considered ambulatory care.
Ambulatory surgical center
Also known as an “in-and-out” center, this is a non-hospital location where outpatient surgery is performed. You might stay at an ambulatory surgical center for a few hours after surgery or up to one night following the procedure.
Americans with Disabilities Act (ADA)
This 1990 federal law prohibits discrimination against people who are disabled and formally describes "disability."
Amount charged
The amount billed for a specific service.
Amount plan pays
This is the dollar amount your benefits plan pays toward your claim(s).
Amount repaid
On the Expenses Requiring Verification Table, this is the amount deposited back into your spending account because you sent repayment for a non-qualified expense.
Amount you pay
This is the amount you must pay your provider(s).
Analgesia is the reduction or elimination of pain.
Ancillary services
Services, other than those a provider performs, are ancillary services. These might include laboratory work, X-rays, and anesthesia.
See General Anesthesia, Intravenous Sedation / Analgesia, Local Anesthesia, Non-Intravenous Conscious Sedation, or Regional Anesthesia.
Annual deductible
The amount of covered expenses you must pay in one year before your insurance plan pays any benefits is your annual deductible. For Medicare Part B, Medicare begins to pay 100% of certain covered expenses as soon as you have met the deductible for the year. For Medicare Part A, deductibles are not based on an annual cycle but on individual benefit periods. See the definitions for benefit period, Medicare Part A, and Medicare Part B.
Annual election
The total amount of FSA or PCA funds the employee selects for the plan year. In some cases, the employer determines the FSA or PCA amount.
Annual election period
You can enroll in Medicare for the first time whenever you become eligible. To change your coverage, though, you need to wait for the annual election period, which runs from October 15 through December 7 of each year. This is when you can join a Medicare Advantage health plan or prescription drug plan. You can enroll in Medicare Supplement plans, however, at any time if you meet the eligibility requirements. See the definition for Medicare Supplement insurance.
Annual maximum
The total amount you'll spend between your plan effective date and the end of your plan year.
Annual maximum benefit
Maximum dollar amount paid by the dental plan in a calendar year or plan year.
Annual Notice of Change (ANOC)
Centers for Medicare & Medicaid Services -mandated notification of yearly plan benefit changes that is sent to enrolled members.
Annual plan premium
This is the total amount you pay for a Humana Medicare plan during the calendar year.
Appeal (Individual & Family)
An appeal is a written request from the enrolled member or the enrolled member's authorized representative, a non-network provider, or court- appointed guardian to reconsider our initial adverse determination to deny coverage of service or payment of a claim, including delay in providing, arranging or approving the healthcare service.
Appeal (Medicare)
You can file an appeal if you were denied a request for healthcare services or payment for services you already received. You can also appeal if you disagree with a decision to stop services you are receiving. Medicare Advantage and Medicare prescription drug plan carriers as well as Medicare Parts A and B must follow a specific process when you ask for an appeal.
You must submit a to a signed application to an insurance company to be considered for a policy.
Applied reserve
The amount of Coordination of Benefits (COB) savings from prior claims applied to pay allowable expenses on subsequent claims. This amount is not otherwise paid by the primary other insurance and regular plan benefits.
Approved amount
The approved amount is the fee Medicare sets as reasonable for a covered medical service. This is the amount you and Medicare pay for a service or supply. The amount may be less than the actual amount charged by a doctor or supplier. The approved amount is sometimes called the approved charge.
In Medicare Parts A and B, assignment means a doctor agrees to accept Medicare's approved amount as full payment. You can save money by going to a doctor who accepts assignment, but you may still have some costs, such as coinsurance. See the definitions for actual charge, approved amount, and coinsurance.
Assignment of benefits
This is an arrangement by which you request that your health benefit payments be made directly to a designated person or facility, such as a doctor or hospital.
Assisted living
This is a living arrangement in which you are assisted with everyday life activities and receive personal care services such as meals, housekeeping, and transportation. This assistance is offered, as needed, to people who still live on their own in a residential facility. In most cases, assisted living residents pay regular monthly rent plus fees for additional services they receive.
Attending physician
Your attending physician is the licensed doctor who has primary responsibility for your medical care and treatment.
You must have a verbal or written authorization from your insurance plan for some services before you receive care.
Authorization for care
This refers to the determination that the requested treatment is medically necessary, delivered in the appropriate setting, a TRICARE benefit, and that the treatment will be cost-shared by the Department of Defense.
Available balance
The amount of funds in your spending account you can use for eligible expenses.