Medical Insurance: D-G

D

Deductible - an amount specified by the insurance plan that the policy holder must pay prior to the insurance administrator/employer contributing to payments.

Dependent - a child who has not reached the age of 19 years-old, or who is between the ages of 19 years old and 24 years old, who is enrolled as a full-time student in an accredited program.

Dependent Coverage - a member of the immediate family who can be included on a policy.

Disabled Dependent - a person who is incapable of caring for and unable to provide for him/herself, due to severe physical or mental impairment.

Dental Care - services and treatment received to prevent or reduce symptoms of disease in the teeth and supporting structures.

Domestic Partner - an individual's partner, the relationship must meet specific criteria to be eligible for coverage.

Dual-coverage - coverage by more than one medical plan.

E

EAP, Employee Assistance Program - services offered to employees to assist with problems that may be affecting the employee's work performance.

ERISA - a federal government law, Employee Retirement Income Security Act of 1974, that sets standards of how insurance in the private sector must be managed.

Electronic claims - the technical method by which a provider sends information to an insurance carrier in order to receive payment for services rendered.

Employee - see individual coverage.

Employee plus Child - a policy designed to cover an individual and a dependent child. The child does not have to reside with the individual.

Employee plus Domestic Partner - a policy designed to cover the individual and a partner in a relationship that meets criteria specified by the government and/or the individual's employer.

Employee plus One - a policy designed to cover the individual and one other person in the employee's immediate family.

Employee plus Spouse - a policy designed to cover the individual and the individual's spouse.

EOB, Explanation of Benefits - the explanation of payment, or denial of payment, sent to the patient.

Exclusions - services or treatments that are not included for reimbursement by an insurance policy.

F

Family -an individual and the immediate family.

Family Coverage - a policy designed to provide coverage for a family, a family is normally defined as 3 or more immediate family members.

Formulary/Non-Formulary - Formulary prescriptions are what is included that a plan will pay for. Non-formulary will not be covered without an authorization, or an exception.

Full Disclosure - complete information is allowed to be given to an approved entity regarding a patient's medical care and coverage.

G

Generic - Prescriptions that are usually the most cost effective, not a brand name.

Group Coverage - insuring a group, the hope is the larger the group will result in lower premiums for both the employer and the employees.