california health insurance Blue cross blue shield
Blue cross california

Home Home Page |  About Us  |  FAQ's Providers  | Applications California Birth Profiles  Contact Us 

California health insurance
California individual health insurance
Health care coverage
Health insurance
Health page insurance
Medical health insurance
Student health insurance
Short term health insurance
Short term insurance
Family health insurance
Group health plan
Self directed health plans Insurance
Health Net Group plans
Kaiser Permanente
Anthem Blue Cross Health Insurance



Dental Insurance Plans
Small group medical plans
Small group dental plans
Short term PPO plans
Self directed health plans
Group health plan
Pharmacy formulary

Personality Business Plans offers affordable health insurance for individuals
Submit your Quote

Health Plan Insurance
Term life Insurance
Dental Plan Insurance
Group Health Insurance
Short-Term Health Insurance

 

Health insurance News

 

Calorie Calculators
Blood - Alcohol Content Calculator
Child Percentiles Calculator

 

 

Glossary of Health Plans

 

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z

Fail First Requirements Favorable Selection FBI
FEHBP Federal Medicaid Managed Care FQHC
Federally Qualified HMO Federal Qualification Fee Disclosure
FFS Fee Schedule Fiduciary
Financial Services Modernization Act First Dollar coverage Fiscal Intermediary
Fiscal Soundness Fixed Costs Flat Fee-Per-Case
Flexible Benefit Plan FSA Formatting
Formulary Formulation Substitution Fully Funded Plan
Functional Health Status Funding Level Funding Method
Funding Vehicle Fraud Freedom of Choice

Fail First Requirements - Drug plans may need an enrollee to try one drug before the plan will pay for another drug. Step therapy aims to control costs by requiring that enrollees use more ordinary drugs which are usually less expensive. The process of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and succeeding to other more costly or risky therapy is called Step Therapy or Fail First Requirement.

Back to top

Favorable Selection - Choice of subscribers or covered lives based on data that shows a propensity for utilization of health services in that population group to be lower than expect or estimated.

Back to top

Federal Bureau of Investigation (FBI) - As an organization under the DOJ, the FBI investigates violations of federal criminal law and provides law enforcement assistance to federal, state, local and international agencies. The FBI has investigated hospitals for deception and abuse.

Back to top

Federal Employee Health Benefits Program (FEHBP) - A charitable health insurance program for federal employees, retirees, and their dependents and survivors.

Back to top

Federal Medicaid Managed Care Waiver Program - The process used by States to obtain permission to implement managed care programs for their Medicaid or other categorically eligible beneficiaries.

Back to top

Federally Qualified Health Center (FQHC) - A federal payment option that enables capable providers in medically underserved areas to receive cost-based Medicare and Medicaid reimbursement and allows for the direct payment of nurse practitioners, physician assistants and certified nurse midwives. Many outpatient clinics and subject outreach services are qualified under this provision that was enacted in 1989.

Back to top

Federally Qualified HMO - A prepaid health plan that has met strict central standards and has been granted qualification status. A federally qualified HMO is qualified for loans and loan guarantees not available to non-qualified plans. Employers of 25 or more workers were, until recently, required to offer a federally practiced HMO if the plan requested to be included in the company's health benefits program.

Back to top

Federal Qualification - A status selected by CMS after conducting an extensive evaluation of an HMO's organization and operations. An organization must be federally capable or be designated as a competitive medical plan (CMP) to be eligible to participate in Medicare and cost and risk contracts.

Back to top

Fee Disclosure - Physicians and caregivers discussing their charges with patients preceding to treatment.

Back to top

Fee-For-Service (FFS) - Traditional technique of payment for health care services where specific payment is made for specific services rendered. Usually people talk of this in contrast to capitation, DRG or per diem discounted rates, none of which are similar to the traditional fee for service method of reimbursement. Under a fee-for-service payment system, expenditures increase if the fees themselves increase, if more units of service are provided, or if more expensive services are substituted for fewer expensive ones.

Back to top

Fee Schedule - A listing of conventional fees or established allowances for specified medical procedures. As used in medical care plans, it usually represents the maximum amounts the program will pay for the particular procedures. The fee resolute by an MCO to be acceptable for a procedure or service, which the physician agrees to accept as payment in full.

Back to top

Fiduciary - Concerning to, or founded upon, a trust or confidence. A fiduciary relationship exists where an individual or organization has an explicit or implicit responsibility to act in behalf of another person's or organization's interests in matters which affect the other person or organization.

Back to top

Financial Services Modernization Act - Legislation that allows meeting among the traditionally separate components of the financial services industry banks, securities firms, and insurance companies.

Back to top

First Dollar coverage - Insurance coverage with no front-end deductible where exposure begins with the first dollar of expense incurred by the insured for any covered benefit.

Back to top

Fiscal Intermediary - The agent that has contracted with providers of service to procedure claims for reimbursement under health care coverage. In addition to treatment for financial matters, it may perform other functions such as providing consultative services or serving as a center for communication with providers and making audits of providers' needs.

Back to top

Fiscal Soundness - The condition that managed care organizations have sufficient operating funds, on hand or available in reserve, to cover all expenses associated with services for which they have assumed financial risk.

Back to top

Fixed Costs - Costs that do not change with fluctuations in census or in use of services.

Back to top

Flat Fee-Per-Case - Flat fee paid for a client's treatment based on their analysis and/or presenting problem. For this fee the providers cover all of the services the client requires for a specific period of time. Often characterizes "second generation" managed care systems. After the MCOs press out costs by discounting fees, they often come to this method.

Back to top

Flexible Benefit Plan - Program accessible by some employers in which employees may choose among a number of health care benefit options.

Back to top

Flexible Spending Account (FSA) - A plan that provides employees an option between taxable cash and non-taxable benefits for unreimbursed health care expenses or dependent care expenses. This plan qualifies below Section 125 of the IRS Code.

Back to top

Formatting and Protocol Standards - Data exchange principles which are needed between CPR systems, as well as CPT and other provider systems, to ensure consistency in methods for data collection, data storage and data presentation. Proactive providers are present in their knowledge of these standards and work to ensure their information systems conform to the standards.

Back to top

Formulary - An accepted list of prescription drugs; a list of selected pharmaceuticals and their appropriate dosages felt to be the most useful and cost efficient for patient care. Organizations often enlarge a formulary under the aegis of a pharmacy and therapeutics committee. When used by hospitals or clinics, a formulary is planned as a recommendation usually and not considered a requirement.

Back to top

Formulation Substitution - As patients and prescription benefit plans request to lower their healthcare costs, they may substitute a less exclusive therapeutically equivalent drug for a more costly drug. Formulation replacement can include switching from a brand-name drug to a generic drug, switching from one generic drug to another generic drug, or switching from a generic drug to a brand-name drug.

Back to top

Fully Funded Plan - A health plan under which an insurer or MCO bears the financial liability of guaranteeing claim payments and paying for all incurred covered benefits and administration costs.

Back to top

Functional Health Status - Refers to a patient's capacity to execute typical daily physical and social or role functions, plus other events of self-perceived health position such as well-being, vitality and mental health.

Back to top

Funding Level - Amount of income required to finance a medical care program.

Back to top

Funding Method - System for employers to pay for a health income plan. Most frequent methods are prospective and / or display premium payment, shared risk collection, self-funded, or refunding products.

Back to top

Funding Vehicle - In a self-funded plan, the account into which the money that an employer and employees would have salaried in premiums to an insurer or MCO is deposited until the money is paid out.

Back to top

Fraud - Intentional misrepresentations that can effect in criminal prosecution, civil liability and administrative sanctions. This is a broad description and can be applied in many different circumstances.

Back to top

Freedom of Choice - A principle of Medicaid that allows a receiver the freedom to choose among participating Medicaid providers. This term is also used by insurance plans to indicate that subscribers may use the providers of their choice.

Back to top

Anthem Blue Cross | Anthem Blue Cross | Anthem Blue Cross rights | Anthem Blue Cross Blue Shield | california department insurance | california health insurance | california individual health insurance | health care coverage | health insurance | health page insurance | individual health insurance | medical health insurance | student health insurance | short term health insurance | short term insurance |Dental plans | small group medical plans | small group dental plans | small group dental plans at a glance | short term ppo plans | short ppo plans | self directed health plans | premium only plan | group health plan | choose plan | pharmacy | pharmacy formulary | pharmacy plan | ppo 500 | ppo 1000 | ppo 2000 | ppo 250 | ppo 40 comprehensive | ppo 40 | ppo 500 | ppo generic | ppo saver | ppo share 5000 | ppo share 1000 |Annuities | Life Insurance | Workers Pension| Long Term Insurance |Insurance Broker|Health Net Group plans | Kaiser Permanente | Anthem Blue Cross Health Insurance | Health Insurance California Articles
 

Health Insurance | Dental Insurance | Blue Cross InsuranceProvider Search | Consumer Information | About Us Contact Us | Site Map| Resources | Health Insurance News | Disclaimers | Health Insurance Buyers Guide | Insurance FAQ's | Glossary | Search engine optimization seo company
Copyright © Quotit Corporation 2001. All righ cts reserved.

Make use of our forhealthplans.com site by utilizing our health insurance online services. This site of California Health Insurance plans for the whole family along with individual health insurance policies. We are valued to provide consistent value and solid protection to individuals and families in all walks of life through our insurance policies We continue to build on new and enhanced health insurance products to meet the changing needs of our customers. We offer a variety of health plans including individual and family health insurance, Health savings account, Individual health plans, family health insurance plans, Blue cross and dental health insurance and help individuals find affordable health insurance and manage their benefits. Join us now.