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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

V   Validation
Variable Contribution Health Plan Vertical Integration Vital Statistics
Volume and Intensity VPS Volume Performance Standards
W   Waiting Periods
Waiver Waiver of Authorization Wellness
Withhold Withhold Pool WHCRA
Workers' Compensation Workers' Compensation Indemnity Benefits  
V

Validation - The procedure by which the integrity and correctness of data are recognized. Validation processes can occur directly after a data item is collected or after a complete set of data is collected.

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Variable Contribution Health Plan - In contrast to a fixed payment plan, a variable contribution involves employers committing to a specific level of benefits funding for its employees, regardless of the actual benefit price.

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Vertical Integration - Organization of production whereby one business entity controls or owns all stage of the production and sharing of goods or services. In health care, vertical integration can take many forms, but, usually implies that physicians, hospitals and health plans have combined their organizations or processes in some method to increase efficiencies, increase competitive strength or to develop quality of care.

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Vital Statistics - Statistics connecting to births, deaths, marriages, health, and disease. Vital statistics for the United States are available by the National Center for Health Statistics. Vital statistics can be obtained from CDC, state health departments, county health departments and other agency.

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Volume and Intensity of Services - The amount of health care services per enrollee, taking into account both the number and the difficulty of the services provided.

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Volume Performance Standard (VPS) System - The VPS provides a device to adjust fee updates for the Medicare Fee Schedule based on how annual increases in real expenditures compare with before determined performance standard rates of increase.

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Volume Performance Standards (VPS) - A mechanism to adjust updates to fee-for-service payment rates based on actual total.

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W

Waiting Periods - The length of time an individual must wait to become qualified for benefits for a specific state after overall coverage has begun. If the employee or needy enrolls as a late enrollee or on a special enrollment date, any period before the late or particular enrollment is not a waiting period.

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Waiver- Approval that the Centers for Medicare and Medicaid Services that the federal agency that administers the Medicaid program, may grant to state Medicaid programs to excused them from exact aspects of Title XIX, the federal Medicaid law.

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Waiver of Authorization - Under HIPAA, under limited circumstances, a waiver of the requirement for approval for use or revelation of private health information may be obtained from the IRB by the researcher. A waiver of authorization can be accepted only if specific criteria have been met.

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Wellness- An active state of physical, mental, and social well-being; a way of life which equips the individual to understand the full potential of his/her capabilities and to overcome and compensate for weaknesses. Wellness has been viewed as the result of four key factors over which an individual has varying degrees of manage: human biology, environment, health care organization and lifestyle.

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Withhold - Used as an incentive to support providers to reduce utilization of services, a percentage of a provider's payment is "held back" during the plan year to equalize or pay for any cost overruns for referral or hospital services. Portion of a claim to deduct and held by a health plan before payment is made to a capitated physician.

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Withhold Pool - The aggregate amount suspended from all providers' capitation payments as an amount to cover overload expenditures of his or a groups referral or other pool.

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Women's Health and Cancer Rights Act (WHCRA) - A law which requires health plans that offer medical and surgical benefits for mastectomy to offer coverage for reconstructive surgery following mastectomy.

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Workers' Compensation - Insurance that employers are necessary to have to cover employees who get sick or injured on the job. Several states have either enact or are to consider changes to the Workers Compensation Laws to allow employers to cover occupational injuries and illnesses within their own existing group medical plans.

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Workers' Compensation Indemnity Benefits - Benefits that replace an employee's wages while the employee is not capable to work because of a work-related injury or illness.

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