accreditation accredited accumulation period administrative services only admitting physician admitting privileges after care agent of record ambulatory care ancillary services any willing provider laws appeal ASO assignment of benefits attachment beneficiary benefit benefit cap board certified broker capitation care plan case management case manager centers of excellence certificate of coverage claim clinical practice guidelines co-insurance co-pay co-payment COB COBRA concurrent review consolidated omnibus budget reconciliation act contract year coordinated care coordination of benefits cost sharing covered benefit covered charges/expenses covered person CPT credentialing creditable coverage critical access hospital current procedural terminology custodial care deductible deductible carry over credit defensive medicine denial of claim dependent designated facility diagnostic related group discharge planning disenroll DRG EAPs effective date eligible dependent eligible expenses employee assistance programs enrollee EOB episode of care evidence of insurability exclusion period exclusions and limitations explanation of benefits fee schedule fee-for-service first dollar coverage flexible benefit plan flexible spending account formulary free-look period FSA full-time student gag rule laws gatekeeper general agent grievance group health plan guaranteed issue HCFA Common Procedure Coding System HCPCS HDHP health care provider health employer data and information set health insurance portability & accountability act health maintenance organization health reimbursement arrangement health savings account HEDIS high deductible health plan HIPAA HMO home health care hospice care hospital care hospital-surgical coverage HRA HSA impaired risk incurral date indemnity health plan independent practice associations inpatient care insured international classification of diseases, 9th revision, clinical modification icd-9-cm IPA lapse lifetime maximum limited policy major medical managed care master policy medicaid medical necessity medical savings account medically necessary medicare medicare supplement medigap misrepresentation morbidity MSA NAIC national association of insurance commissioners national committee for quality assurance national drug code NCQA NDC network network provider noncancellable policy nonrenewable open enrollment out-of-network out-of-plan out-of-pocket costs out-of-pocket maximum participating provider PCP permanent insurance policy policy year policyholder portability PPO pre-admission review pre-admission testing pre-authorization pre-certification pre-existing condition preferred provider organization pregnancy care premium preventive care primary care physician prior authorization provider qualifying event R&C charge reasonable and customary referral renewal rider risk schedule of benefits and exclusions second surgical opinion self administered self-insured service area short-term medical insurance SIC skilled nursing facility special benefit networks staff model standard industrial classification state insurance department state-mandated benefits stop-loss provisions third-party payer underwriting urgent care usual and customary charge utilization review waiting period well-baby care wellness office visit workers compensation