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| HCFA |
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See Health Care Financing Administration (HCFA).
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| HCFA 1500 |
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A form used by Providers of Health Services to bill their fees to health Carriers. It was developed by the government agency known as Health Care Financing Administration (HCFA).
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| HCFA Common Procedure Coding System (HCPCS) |
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Name given to CPT codes (Level I), alphanumeric codes (Level II), and local codes (Level III) used by payers and Providers for billing purposes. Within the industry, most refer to
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| HCQIA |
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See Health Care Quality Improvement Act (HCQIA).
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| HCQIP |
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See Health Care Quality Improvement Program (HCQIP).
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| Health Benefits Package |
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The Coverages offered by a Health Plan to an individual or group.
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| Health Care Financing Administration (HCFA) |
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Part of the Department of Health and Human Services, responsible for administration of theMedicare andMedicaid programs. The HCFA establishes standards for medical Providers which must be complied with if the Provider is to meet certification requirements.
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| Health Care Practitioner |
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A person licensed by the state or other geographic area in which the Covered Charges are rendered to treat the kind of Sickness or Injury for which a Claim is made. The Health Care Practitioner must be practicing within the limits of his or her license and in the geographic area in which he or she is licensed.
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| Health Care Provider |
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A doctor, hospital, laboratory, nurse, or anyone who delivers medical or health-related care
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| Health Care Quality Improvement Act (HCQIA) |
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A federal act which exempts Hospitals, group practices, and HMOs from certain antitrust provisions as they apply to Credentialing and Peer Review so long as these entities adhere to due process standards that are outlined in the Act.
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| Health Care Quality Improvement Program (HCQIP) |
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A program, established by the Balanced Budget Act of 1997, that seeks to improve the Quality of care provided to a Medicare Beneficiarys by requiring Medicare+Choice Coordinated Care plans to undergo periodic Quality review by Peer Review Organizations (PROs).
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| Health Employer Data and Information Set (HEDIS) |
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A set of standard Performance Measures that provides information about the Quality of a Health Plan. These measures are used to compare Managed Care Plans.
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| Health History |
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A form used by underwriters to assist in evaluating groups or individuals to determine whether they are acceptable risks.
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| Health Information Network (HIN) |
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An electronic system that uses telecommunications devices to link various healthcare entities within a geographic region in order to Exchange patient, clinical, and financial information in an effort to reduce costs and practice better medicine.
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| Health Insurance (HI) |
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Insurance against loss by Sickness or bodily Injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily Injury, Sickness or disease, and medical expense. The term Health Insurance is now used to replace such terms as Accident Insurance, Sickness Insurance, Medical Expense Insurance, Accidental Death Insurance, and Dismemberment Insurance. The form is sometimes called Accident and Health, Accident and Sickness, Accident, or Disability Income Insurance.
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| Health Insurance Association of America (HIAA) |
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An association supported by Life and Health insurers to provide the research, public relations, education, and legislative base for the promotion of voluntary private Health Insurance (HI).
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| Health Insurance Institute (HII) |
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The public relations arm of the Health Insurance Association of America (HIAA). It provides for a flow of information from Health insurers to the public and from the public to the insurers.
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| Health Insurance Portability And Accountability Act (HIPAA) |
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A federal act that protects people who change jobs, are self-employed, or who have pre-existing medical conditions. HIPAA standardizes an approach to the Continuation of healthcare Benefits for individuals and Members of small Group Health Plans and establishes parity between the Benefits extended to these individuals and those Benefits offered to employees in Large Group plans. The act also contains provisions designed to ensure that prospective or current Enrollees in a Group Health Plan are not discriminated against based on health status.
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| Health Insurance Purchasing Co-Ops (HPCS) |
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See Purchasing Alliances.
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| Health Insurance Quality Award (HIQA) |
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An award granted annually by the International Association of Health Underwriters or the National Association of Life Underwriters for high persistency of Health Insurance (HI) policies written by agents. See also Persistency.
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| Health Maintenance Organization (HMO) |
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Prepaid Health Plans which cover doctors' visits, Hospital stays, Emergency care, surgery, Preventive Care, checkups, lab tests, X-rays, and therapy. In a HMO, one must choose a Primary Care Physician (PCP) who coordinates all care and makes Referrals to any specialists that may be required. In a HMO, one must use the doctors, Hospitals and clinics that participate in your plan's Network. No Benefits are paid for non-emergency Benefits provided outside the HMO Network.
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| Health Plan |
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This refers to any kind of plan that covers health care services such as HMOs, insured plans, Preferred Provider Organization (PPO), etc.
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| Health Reimbursement Arrangement (HRA) |
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A tax-advantaged employee health spending account funded and owned by the employer. Funds remaining in the account at year-end revert to the employer. For the employee, HRAs are a "use it or lose it" proposition.
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| Health Savings Account (HSA) |
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Operating similarly to IRAs, HSAs are tax-advantaged savings accounts for health care services. A person must enroll in a qualified High Deductible Health Plan (HDHP) (HDHP) before they can establish an HSA.
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| Health Service Agreement (HSA) |
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The agreement between employer and the Health Plan which outlines a description of Benefits, Enrollment procedures, eligibility standards, etc.
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| Health Services |
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The Benefits covered under a health contract.
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| Healthcare Quality |
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The degree to which Health Services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
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| HI.2 |
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See Health Insurance (HI) and Medicare Part A.
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| HIAA |
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See Health Insurance Association of America (HIAA).
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| High Deductible Health Plan (HDHP) |
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A person must be enrolled in a qualified High Deductible Health Plan (HDHP) (HDHP) before they can establish a Health Savings Account (HSA). Not all High Deductible Health Plan (HDHP)s qualify for purposes of establishing HSA eligibility. A qualified HDHP Benefit Design must conform to various federally-mandated requirements, such as a minimum $1000 Deductible and a lack of first-dollar Benefit provisions.
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| HII |
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See Health Insurance Institute (HII).
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| HIN |
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See Health Information Network (HIN).
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| HIPAA |
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See Health Insurance Portability And Accountability Act (HIPAA).
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| HMO |
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See Health Maintenance Organization (HMO).
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| HMO Act |
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1973 federal law that ensured Access for HMOs to the employer-based insurance market.
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| Hold Harmless Provision |
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A contract clause which forbids Providers from seeking compensation from patients if the Health Plan fails to compensate the Providers because of insolvency or for any other reason.
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| Home Health Agency |
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A certified facility approved by a Health Plan to provide services under contract.
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| Home Health Care |
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Services given at home to aged, disabled, sick, or convalescent individuals not needing institutional care. The most common types of home care are visiting nurse services and Speech Therapy, Physical Therapy, Occupational Therapy, and rehabilitation therapy. These services are provided by home health agencies, Hospitals, or other community organizations.
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| Home Health Care Agency |
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An organization:
1. Whose primary purpose is to provide Home Health Care; and
2. Which is certified byMedicare; and
3. Which is licensed as a Home Health Care Agency by the state in which it provides services.
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| Home Health Services |
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Health care services provided by a licensed Home Health Agency in the patient's home which is a covered expense under Medicare Part A.
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| Home Office |
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The Insurance Carrier's administrative offices.
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| Hospice |
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An organization that provides medical services in an Inpatient, Outpatient or home setting to support and care for person who are Terminally Ill with a life expectance of 6 months or less and certified by a physician. A Hospice must meet all of the following requirements:
1. Comply with all state licensing requirements.
2. Be Medicare certified and/or Accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
3. Provide a treatment plan and services under the direction of a physician.
An Inpatient Hospice facility must meet all of the following requirements in addition to the requirements above:
1. Be a dedicated unit within an Acute Medical Facility (Hospital) or a Subacute Rehabilitation Facility or a separate facility that provides Hospice services on an Inpatient basis.
2. Be licensed by the state in which the services are rendered to provide Inpatient Hospice services.
3. Be staffed by an on call physician 24 hours per day.
4. Provide nursing services supervised by an on duty registered nurse 24 hours per day.
5. Maintain daily clinical records.
6. Admit patients who have a terminal illness.
7. Not provide patients with services that involve active intervention for the terminal illness although ongoing care for comorbid conditions and palliative care for the terminal illness may be provided.
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| Hospice Care |
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Care for the Terminally Ill and their families, in the home or a non-hospital setting, that emphasizes alleviating pain rather than a medical cure
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| Hospital |
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See Medical Facility - Acute (Hospital).
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| Hospital Affiliation |
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A contract whereby one or more Hospitals agrees to provide Benefits to Members of a specific Health Plan.
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| Hospital Alliances |
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A group of Hospitals that work together to share common services and thereby reduce health costs. By grouping together, they are better able to compete with other alliances or chains.
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| Hospital Benefits |
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Benefits payable for Hospital room and board, plus miscellaneous charges resulting from hospitalization.
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| Hospital Care |
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Reimbursement for both Inpatient and Outpatient medical care expenses incurred in a Hospital. Inpatient Benefits include; Charges for room and board, charges for necessary services and supplies sometimes referred to as 'hospital extras,' 'other Hospital extras,' 'miscellaneous charges,' and Outpatient Rx - Ancillary Charges. Outpatient Benefits include; surgical procedures, rehabilitation therapy, and Physical Therapy.
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| Hospital Expense Insurance |
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See Hospitalization Insurance.
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| Hospital Income Insurance |
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A form of insurance that provides a stated weekly or monthly payment while the Insured is hospitalized, regardless of expenses incurred and regardless of whether or not other insurance is in force. The Insured can use the weekly or monthly Benefit as he chooses, for Hospital or other expenses.
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| Hospital Indemnity |
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Coverage that pays based on daily, weekly, or monthly limits regardless of the amount of actual Hospital expenses.
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| Hospital Insurance (HI) |
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Also identified as Medicare Part A (Part A ofMedicare). HI provides Inpatient Hospital Care, Skilled Nursing Care, home health and Hospice Care subject to a Benefit Period Deductible and Copayments for certain services.
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| Hospitalization Expense Policy |
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A Policy which covers daily Hospital room and board charges and also covers miscellaneous Hospital expenses (such as X-ray, etc.). It also often covers Emergency Treatment charges and many times will also include a surgical Benefit.
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| Hospitalization Insurance |
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A form of insurance that provides reimbursement within contractual limits for Hospital and specific related expenses arising from hospitalization caused by Injury or Sickness.
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| Hospital-Surgical Coverage |
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A form of Health Insurance (HI) that offers Coverage of certain costs related to hospitalization and surgical procedures. A hospital-surgical plan does not cover other types of medical services, such as physician Office Visits and Outpatient Prescription Drugs.
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| House Confinement |
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A provision in some Health Insurance (HI) contracts which requires an Insured to be confined to the house in order to be eligible for Benefits. This provision is most commonly found in policies providing loss of income Benefits.
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| Hunter Disability Tables |
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Tables which show the probability of total and permanent disability.
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