| insurance claim review | Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality. (12 Dec 1998) |
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| insurance coverage | Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (slee & slee, health care terms, 2d ed) (12 Dec 1998) |
| insurance pools | An organization of insurers or reinsurers through which particular types of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts. (12 Dec 1998) |
| insurance selection bias | Adverse of favourable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people. (12 Dec 1998) |
| insurance, accident | Insurance providing coverage for physical injury suffered as a result of unavoidable circumstances. (12 Dec 1998) |
| insurance, dental | Insurance providing coverage for dental care. (12 Dec 1998) |
| insurance, disability | Insurance designed to compensate persons who lose wages because of illness or injury; insurance providing periodic payments that partially replace lost wages, salary, or other income when the insured is unable to work because of illness, injury, or disease. Individual and group disability insurance are two types of such coverage. (12 Dec 1998) |
| insurance, health | Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading. (12 Dec 1998) |
| insurance, health, reimbursement | Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (12 Dec 1998) |
| insurance, hospitalization | Health insurance providing benefits to cover or partly cover hospital expenses. (12 Dec 1998) |
| insurance, liability | Insurance against loss resulting from liability for injury or damage to the persons or property of others. (12 Dec 1998) |
| insurance, life | Insurance providing for payment of a stipulated sum to a designated beneficiary upon death of the insured. (12 Dec 1998) |
| insurance, long-term care | Health insurance to provide full or partial coverage for long-term home care services or for long-term nursing care provided in a residential facility such as a nursing home. (12 Dec 1998) |
| insurance, major medical | Insurance providing a broad range of medical services and supplies, when prescribed by a physician, whether or not the patient is hospitalised. It frequently is an extension of a basic policy and benefits will not begin until the basic policy is exhausted. (12 Dec 1998) |
| insurance, medigap | A supplemental health insurance policy sold by private insurance companies and designed to pay for health care costs and services that are not paid for either by medicare alone or by a combination of medicare and existing private health insurance benefits. (12 Dec 1998) |