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Industry Glossary
Data Dictionary Services
Industry Glossaries:
 
Health Care
                 
 Third Party Administrator
Category
 

 

Health Care
 Buydown
Category
 

A revision in a benefit plan (such as an increase in co-payment) that results in a reduced premium.

 

Health Care
 Copayment
Category
 

The portion of medical expenses for which the HMO member is responsible.

 

Health Care
 Medical loss ratio
Category
 

The measure of total costs that are expended on healthcare as a percentage of total premium reserves.

 

Health Care
 Preferred Provider Organization (PPO)
Category
 

A health care organization that almost completely pays for services obtained from its network of "preferred" providers, but only partially pays for services obtained from out-of-network providers.

 

Health Care
 Managed Care
Category
 

A method of delivering and paying for healthcare through a system of provider networks. Managed care plans include HMO's , preferred provider organizations (PPO), and point-of-service (POS) plans.

 

Health Care
 Provider
Category
 

A physician who provides healthcare to patients. Medical facilities can also be referred to as providers.

 

Health Care
 Medicaid
Category
 

A health benefit program for low-income U.S. residents who are aged, blind, disabled, or who are members of families with dependent children. The states and federal government jointly fund Medicaid but each state sets eligibility standards.

 

Health Care
 Medicare
Category
 

A federally funded U.S. health insurance program for persons 65 and older, and all disabled persons regardless of age and income.

 

Health Care
 Ambulatory Care
Category
 

Nonemergency healthcare services given to patients who donít require overnight hospitalization.

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Health Care
 Acute Care
Category
 

Hospital care focused on a patient whose physical or mental condition requires immediate intervention and constant medical attention, equipment , or personnel.

 

Health Care