Assignment of Benefits – An authorization you sign to your doctor or hospital (medical provider) that “assigns” payment to be made directly to them for whatever treatment you receive in the hospital or doctors office.

Business Day – Typically Monday through Friday, in which a health insurance company is open for business. They tend to be closed on Saturday’s, Sunday’s, and most state recognized holidays.

Calendar Day – Includes any day that is on the calendar each month, including Saturday, Sunday, and state and federal holidays. That being said, if any action tied to a time frame in an insurance policy or CDI regulation or code falls on a Saturday, Sunday, or state or federal holiday; then that particular act is postponed to the next calendar day that does not fall on a Saturday, Sunday, or state or federal holiday.

Certificate of Coverage – This is a document issued to a member of a group health insurance plan, which indicates evidence of that member participating in the groups insurance plan.

Certificate of Creditable Coverage – A written statement from your previous insurance carrier showing the length of time you were covered.

Creditable Coverage or Prior Qualifying Coverage – How long in months you had health coverage in place before your existing or new policy went into effect. Creditable coverage must be counted towards any preexisting condition exclusion in either an individual or group policy.

Claim – When you need to use your insurance a notification to your insurance company shows that payment is due under the policy provisions.
Co-payment – Typically a percentage or specified dollar amount that you pay to your provider for covered health care services in addition to any deductible.

Coverage – The benefits in an insurance policy which includes the entire scope of protection in an insurance contract.

Denial – When you apply for insurance but get rejected. Several factors can contribute to an individual being Denied for coverage. Also in terms of claims, a insurance company may decide to withhold a claim payment or pre-authorization. This can happen for may reasons as well, possibly because the medical service is not covered, not medically necessary, or experimental or investigational.

Deductible – The amount which is usually fixed, a member must pay before benefits from the insurance company are payable.

ERISA – Stands for the Employee Retirement Income Security Act (1974). Administered by the U.S. Department of Labor, Employee Benefits Security Administration. ERISA regulates employer-sponsored pension and insurance plans (self-insured plans) for employees.