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

J J-Codes Job-Lock
JCAHO Joint Venture Justice or Equity
K Key Contributor Plan  
L Large Claim Pooling Large Group
Large Local Groups Large Urban Area Legacy Systems
Legend Drug Length of Stay Licensing
Lifetime Limit Lifetime Maximum Benefit Lifetime Reserve Days
Limitations Limited Data Set Limiting Charge
LATA Local Codes LEC
Lock-in LTC Long-term Care Insurance
LTD Loss Rate Loss Ratio
J

J-Codes - A subset of the HCPCS Level II code set with a high-order value of "J" that has been used to recognize certain drugs and other items.

Back to top

Job-Lock - Laws have now been enacted by congress which includes continuation of benefits (COBRA) and other requirements which eliminate pre-existing clauses for those individuals who change coverage plans but have maintained continuance of coverage in general. The inability of individuals to alter jobs because they would lose crucial health benefits.

Back to top

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) - Previously called JCAH or Joint Commission on Accreditation of Hospitals, this is the examine review organization which provides the primary review of hospitals and healthcare providers. Many insurance companies require providers to have this certification in order to seek 3rd party payment, although, many small hospitals cannot afford the cost of accreditation.

Back to top

Joint Venture - A type of partial structural integration in which one or more part organizations combine resources to achieve a stated objective. For example, independent practice associations can split ownership of a venture and responsibility for its operations, but still maintain separate ownership and control over their operations outside of the joint venture.

Back to top

Justice or Equity - An moral principle, which, when applied to managed care, states that managed care organizations and their providers allocate resources in a way that fairly distributes benefits and burdens among the members.

Back to top

K

Key Contributor Plan - This refers to a little known performance-based program with incentives for the reason of attracting, motivating and retaining key individuals or small groups.

Back to top

L

Large Claim Pooling - System that isolates claims over a certain level and charges them to a pool funded by charges of all groups who share the pool. Considered to help stabilize significant premium fluctuations.

Back to top

Large Group - A large pool of individuals for which health coverage is provided by the group support. A large group may be distinct as more than 250, 500, 1,000, or some other number of members, depending on the MCO.

Back to top

Large Local Groups - Accounts that agreement on a local basis for group employee health benefits.

Back to top

Large Urban Area - An urban geometric region with population of one million or more.

Back to top

Legacy Systems - Computer applications, both hardware and software, which have been inborn through previous acquisition and installation. Most often, these systems run business applications that are not included with each other. Newer systems which stress open design and dispersed processing capacity are gradually replacing such systems. This term is used often in discussing HIPAA and its computing requirements.

Back to top

Legend Drug - Drug that the law says can only be obtained by instruction.

Back to top

Length of Stay (LOS) - The duration of an event of care for a covered person. The number of days an individual stays in a hospital or inpatient ability.

Back to top

Licensing - A procedure most States employ, which involves the review and approval of applications from HMOs prior to beginning operation in certain areas of the State. Areas examined by the licensing authority which includes fiscal soundness, network capacity, MIS, and quality assurance. The applicant must show it can meet all existing statutory and regulatory requirements prior to beginning operations.

Back to top

Lifetime Limit - A limit on the benefits paid under a policy. For example, many policies have a lifetime limit of $1 million, which means that the insurer agrees to wrap up to $1 million in covered services over the life of the policy.

Back to top

Lifetime Maximum Benefit - The maximum amount a health plan will pay in benefits to an insured individual.

Back to top

Lifetime Reserve Days - In the Original Medicare Plan, a total of 60 additional days that Medicare will pay for when an enrollee is in a hospital more than 90 days during a benefit period. Once these 60 reserve days are used, the citizen does not obtain any more extra days during his or her lifetime. For each lifetime reserve day, Medicare pays all covered costs apart from a daily coinsurance.

Back to top

Limitations - A restriction on the amount of benefits paid out for a particular covered expense.

Back to top

Limited Data Set - Under HIPAA, this expression refers to a set of data that may be used for research, public health or health care operations without an approval or waiver of authorization. A covered entity must penetrate into a data use agreement with the recipient of a limited data set. It should be noted that even though a limited data set is subject to only to choose provisions of the HIPAA Privacy Rule, it may be covered by the Common Rule.

Back to top

Limiting Charge - The maximum amount that a non-participating physician is allowable to charge a Medicare beneficiary for a particularly defined procedure or bundled service. These limits are available by the individual state intermediaries for Medicare and CMS and are usually combined in reports with the allowed charges and regional payment schedules. In 1993, the limiting charge was placed at 115 percent of the Medicare-allowed charge.

Back to top

Local Access Transport Area (LATA) - A definite region in which a telephone and long distance carrier operates. Important idea for those CHINs that depend upon phone lines. When creating communications networks, you try to avoid crossing boundaries of these, if possible, since costs rise dramatically when there is a need to communicate over more than one LATA.

Back to top

Local Codes - A generic word for code values that are defined for a State or other local division or for a specific payer. Commonly used to explain HCPCS Level III Codes.

Back to top

Local Exchange Carrier (LEC) - The telephone company that provides and supports the local association to the public switched telephone network. In a lot of areas of the US, the LEC is one of the seven regional Bell operating companies (RBOCs) or "Baby Bells," although these companies are undergoing dramatic mergers now. These LECs become partners for organizations looking to develop a CHIN or, more conservatively, simply seeking to integrate their information system across many sites within a region.

Back to top

Lock-in - A contractual provision by which members are necessary to use certain health care providers in order to receive coverage.

Back to top

Long-term Care (LTC) - A set of health care, personal care and social services required by persons who have lost, or never acquired, some degree of useful capacity in an institution or at home, on a long-term basis. Long-term care can be provided at home, in the community, or in various types of services, including nursing homes and assisted living facilities. Ambulatory services such as home health care which can also be providing on a long-term basis are seen as alternatives to long-term institutional care.

Back to top

Long-term Care Insurance - Insurance planned to pay for some or all of the costs of long term care.

Back to top

Long-Term Disability (LTD) - Insurance which pays employees a percentage of monthly earnings in the event of disability.

Back to top

Loss Rate - The number and timing of losses that will occur in a given group of insured's while the coverage is in force.

Back to top

Loss Ratio - Incurred claims plus expenses, separated by paid premiums.

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.