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| Family Counseling |
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Family Counseling is generally falls under the category of Behavioral Health.
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| Family Deductible |
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See Deductible - Family.
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| Family Dependent |
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A person entitled to Coverage because he or she is: 1. The Enrollee's spouse, or 2. A single Dependent child of either the Enrollee or the Enrollee's spouse (including stepchildren or legally adopted children), and 3. A resident of the Enrollee's home.
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| Family Expense Policy |
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A Policy which insures the medical expenses of all members of a family.
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| Family Out-of-Pocket Limit |
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See Out-of-Pocket Limit - Family.
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| Family Plan |
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A plan of insurance covering the Certificate Holder and one or more of the Certificate Holder's Dependents.
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| FASB |
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The Financial Accounting Standards Board (FASB).
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| Federal Employee Health Benefits Program (FEHBP) |
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A voluntary Health Insurance (HI) program administered by the Office of Personnel Management (OPM) for federal employees, retirees, and their Dependents and survivors.
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| Federal Qualification |
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Approval of any HMO made by the HCFA after conducting their evaluation of methods of doing business, documents, contracts, facilities, and systems.
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| Federal Trade Commission Act |
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A federal act which established the Federal Trade Commission (FTC) and gave the FTC power to work with the Department of Justice to enforce the Clayton Act. The primary function of the FTC is to regulate unfair competition and deceptive business practices, which are presented broadly in the Act. As a result, the FTC also pursues violators of the Sherman Antitrust Act. See also Antitrust Laws.
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| Fee Allowance |
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See Fee Schedule.
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| Fee Maximum |
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The maximum amount available to a Provider for specific health care services under a contract. Also see Fee Schedule.
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| Fee Schedule |
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The fee determined by an MCO to be acceptable for a procedure or service, which the physician agrees to accept as payment in full. Also known as a fee allowance, Fee Maximum, or capped fee.
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| Fee-for-Service |
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A payment system for health care where the Provider is paid for each service rendered rather than a pre-negotiated amount for each patient
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| Fee-For-Service (FFS) Payment System |
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A system in which the insurer will either reimburse the Group Member or pay the Provider directly for each covered medical expense after the expense has been incurred.
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| Fee-for-Service Equivalency |
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The difference between the amount a Provider receives from a reimbursement system such as Capitation (CAP) (a flat charge per month, for instance) compared to Fee-For-Service (FFS) Payment System.
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| Fee-for-Service Reimbursement |
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A health care system where physicians and other Providers receive payment based on their billed charge for each service provided.
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| FEHBP |
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See Federal Employee Health Benefits Program (FEHBP).
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| FFS Payment System |
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See Fee-For-Service (FFS) Payment System.
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| Field Underwriting |
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The initial screening of prospective buyers of Health Insurance (HI), performed by sales personnel "in the field." May also include quoting of Premium rates.
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| Finance Committee |
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Committee of the board of directors whose duty it is to review financial results, approve budgets, set and approve spending authorities, review the annual audit, and review and approve outside funding sources.
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| Finance Director |
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Chief financial officer responsible for the oversight of all financial and accounting operations, such as billing, management information services, Enrollment, and Underwriting as well as accounting, fiscal reporting, and budget preparation.
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| Financial Accounting Standards Board (FASB) |
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A non-governmental group that sets standards for generally accepted accounting principles.
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| First Dollar Coverage |
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Refers to not having to meet a Calendar Year Deductible prior to receiving reimbursement or payment for a medical service
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| Fiscal Intermediary |
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A commercial insurer contracted by the Department of Health and Human Services for the purpose of processing and administering Medicare Part A Claims.
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| Flat Maternity Benefit |
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A stipulated Benefit in a Hospital Reimbursement Policy that is paid for maternity confinement, regardless of the actual cost of the confinement.
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| Flexible Benefit Plan |
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A type of program where employees can tailor their Benefits to meet their own specific needs.
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| Flexible Spending Account (FSA) |
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An employee Benefits cash account from which non-taxable withdraws can be made to fund Eligible Expenses defined by the employer-sponsored plan. The FSA is funded by reductions in
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| Food and Drug Administration (FDA) |
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The FDA oversees approval and regulation of all Prescription Drugs, both Brand-name and generic. Its goals include safety, efficacy and Quality.
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| Formulary |
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A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given managed population and that are to be used by an MCO's Providers in prescribing medications. Also known as Drug Formulary and in Medicare Part D programs sometimes called Preferred-Drug List or Drug Guideline.
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| Franchise Insurance |
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A plan for covering Groups of persons with individual policies having Uniform Provisions, although they may differ in Benefits. Individual Contracts are issued to each person with individual Underwriting. It is usually applied to groups too small to qualify for true group Coverage, and the solicitation of cases usually takes place among an employer's work force with his consent. In Life Insurance, it is sometimes called Wholesale Insurance. Contrast with True Group Insurance.
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| Fraternal Insurance |
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Insurance offered a special Group of people, namely, members of a lodge or a fraternal order. Such insurance may be written on an assessment basis or on a legal reserve basis.
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| Free Examination Period |
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This is also known as a "Free Look." It is the time period after an insurance Policy is delivered during which you can decide whether to keep it or return it to the company for a full refund of the initial Premium.
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| Free Look |
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This is also known as a "Free Examination Period." It is the time period after an insurance Policy is delivered during which you can decide whether to keep it or return it to the company for a full refund of the initial Premium. Typically a 10-day period during which a newly insured person can cancel a policy and receive a full refund of paid Premium.
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| Free-Standing Emergency Medical Service Center |
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A facility whose primary purpose is the provision of care for Emergency medical conditions. Also called Emergi-Center or Urgi-Center.
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| Free-Standing Facility |
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See Medical Facility - Free-Standing Facility.
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| Free-Standing Outpatient Surgical Center |
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A facility which only provides Outpatient surgical services. Also called Surgi-Center.
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| Frequency |
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The number of times a service is provided over a given time period.
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| Fringe Benefits |
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See Employee Benefit Program.
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| Full-Time Student |
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Under a Health Plan, an eligible dependant child student (typically age 19 or older) who meets the Health Plan's criteria of "full-time." Such criteria normally typically includes minimum credit hour requirements (such as 12 credit hours in a semester) and a maximum age (age 23 is typical.)
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| Fully Funded Plan |
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A Health Plan under which an insurer or MCO bears the financial responsibility of guaranteeing Claim payments and paying for all incurred Covered Benefits and administration costs.
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| Functional Status |
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A patient's ability to perform the activities of daily living.
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| Funding Level |
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The dollar amount required to purchase a particular medical care program. Usually measured by the Premium rate for an insured program, or an amount assessed for expected Claim loss and related fees under a self-funded program.
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| Funding Methods |
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The agreed means by which an employer pays for health Coverage. Future Increase Option. An option which allows the Insured to increase disability income Benefits at predetermined times, specified in the Policy, without Evidence of Insurability.
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| Funding Vehicle |
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In a Self-Funded Plan, the account into which the money that an employer and employees would have paid in Premiums to an insurer or MCO is deposited until the money is paid out.
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