C
case management
A utilization management technique that addresses the medical necessity of care as well as alternative treatments or solutions, especially when the patient is likely to require very expensive treatment.
certificate of insurance
A document that describes the type and length of coverage provided by a group insurance policy that is given to each insured by the group policyholder.
Chemical Dependency -- Inpatient
Many insurance plans cover treatment for substance abuse detoxification and treatment. Most plans, however, place limits or exclusions on treatment, such as limiting the number of days a patient may stay at a treatment facility or the number of times a patient may go in for treatment, or requiring care to be either on an inpatient or outpatient basis.
Chemical Dependency -- Outpatient
Many insurance plans cover treatment for substance abuse detoxification and treatment. Most plans, however, place limits or exclusions on treatment, such as limiting the number of times a patient may go in for treatment or requiring care to be either on an inpatient or outpatient basis.
Child(ren)-only coverage
For child(ren)-only coverage (neither parent will be covered): For one child, enter the information on that child in the "Enter Your Information" section. For multiple children, each child must be entered and submitted separately. At this time we cannot quote children under 1 year of age separately online. Please call 1-800-942-9019 for an offline quote or more information.
Some carriers offer discounts for multiple children on the same policy; please call 1-800-942-9019 for more information.
chiropractic care
Not all plans cover chiropractors -- practitioners who manipulate the spine and other structures within the body to relieve pain and tension resulting from posture, stress or strain. Some plans offer chiropractic care as an optional benefit that you or your employees may choose to add at an additional cost.
Choice of Doctor
Dependent upon which type of health plan you select, the method of choosing your doctor varies in important ways. In an indemnity plan, you may go to any doctor you choose and your insurance company will reimburse you. If you select an HMO (Health Maintenance Organization), you must choose a "gatekeeper" general practitioner within the network who will refer you to specialists if needed. If you decide to enroll in a PPO (Preferred Provider Organization), you may choose any doctor in the network. You do not need permission to see specialists.
claim
A request for payment under the terms of an insurance policy.
claim examiner
An insurance company employee/representative who is responsible for carrying out the claim examination process. Also known as claim approver, claim analyst, or claim specialist.
COBRA (Consolidated Omnibus Budget Reconciliation
COBRA requires organizations with twenty or more employees to offer the continuation of group health benefits (Medical, Dental, Vision, and Medical Reimbursement Account) to employees (and covered dependents) upon experiencing a "Qualifying Event."
Employers are required to provide initial COBRA notification to covered employees and dependents. A letter detailing an individual's rights upon experiencing a "qualifying event" and an explanation of the conversion privilege. The legislation defines the following six situations as "Qualifying Events" that require COBRA continuation: - Termination of Employment
- Reduction of Work Hours
- Employee's Death
- Employee's Divorce (or legal separation in some states)
- Medicare Entitlement
- Change in "Dependent" Status
Coinsurance
Coinsurance is the amount that you are obligated to pay for medical services after you have satisfied your co-payment or deductible required by your health insurance plan. Coinsurance is usually a percentage of the charge for a service rendered by a healthcare provider. For example, if your health insurance plan covers 70% of the allowable charge for a specific service, you may be required to pay the remaining 30% as coinsurance.
Coinsurance -- Plan Pays
Coinsurance is a method of cost-sharing where the insured must pay a percentage of all remaining medical expenses once the deductible has been met. We list the percentage the plan will pay after the deductible is met, not the percentage you or your employees will pay.
commission
The amount of money, usually a percentage of the premiums, that is paid to an insurance agent for selling an insurance policy.
comprehensive major medical policy
A health insurance policy that covers both major medical expenses (i.e., hospitalization and surgeries) and basic medical expense coverages.
copay
The fee you pay for certain medical services or for each prescription. For example, you may pay $20 for an office visit or $10 to fill a prescription and the health plan covers the balance of the charges.(1) A fee that many insurance plans require an insured to pay for certain medical services (such as a physician's office visit). (2) An amount that the insured must pay toward the cost of each prescription under a prescription drug plan.
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