|
|
|
Word
|
Definition
|
|
|
|
California State Disability Insurance (SDI) Law
|
California State Disability Insurance (SDI) Law: Mandates a non-occupational, short-
term disability plan funded through a tax-supported state fund; in effect since 1946.
Employers may substitute a private, self-insured plan exceeding state fund standards;
additional cost is funded by employer, employees, or both.
|
|
|
|
|
|
|
|
Case Management (Integrated)
|
Case Management (Integrated): Coordination of short and long-term disability, health
care, workers' compensation, ergonomics, and return-to-work programs to improved care
delivery, streamline claims administration, and return employees to work.
|
|
|
|
|
|
|
|
Ceding Company
|
Ceding Company: See reinsurance.
|
|
|
|
|
|
|
|
Census Data
|
Census Data: Information such as date of birth, sex, income, or occupation on persons
eligible for or insured by a group policy; used to determine premium rates or benefits.
|
|
|
|
|
|
|
|
Chronic Disease
|
Chronic Disease: A condition whose symptoms may be ameliorated with treatment but
the underlying condition cannot be cured.
|
|
|
|
|
|
|
|
Claim
|
Claim: 1) A demand to an insurer or third-party administrator by, or on behalf of, a covered
person of disability or workers' compensation benefits requesting payment under the terms
of the policy. 2) A written request by a health care provider to receive payment for services
provided.
|
|
|
|
|
|
|
|
Claim, Closed
|
Claim, Closed: A claim under which all contractual benefits have been paid.
|
|
|
|
|
|
|
|
Claim, Controverted
|
Claim, Controverted: In workers' compensation, a claim that has been questioned in whole or part
by the insurer, third-party administrator, or self-insured employer.
|
|
|
|
|
|
|
|
Claim, Incurred
|
Claim, Incurred: The dollar amount of an insurer's liability at a certain point in time: the
sum of paid claims, open claim reserves, and incurred but unreported claim reserves,
discounted for interest earnings.
|
|
|
|
|
|
|
|
Claimant
|
Claimant: An individual who submits a claim.
|
|
|
|
|
|
|
|
Confidentiality
|
Confidentiality: The degree of protection afforded individually identifiable health
information. When sharing information and records about an individual, insurers and
employers must respect an individual's right to privacy.
|
|
|
|
|
|
|
|
Contributory Insurance
|
Contributory Insurance: A type of employer-sponsored coverage for which the covered
employee pays a portion of the premium cost. The same portion of any benefit received is
tax-free to the employee.
|
|
|
|
|
|
|
|
Current Procedural Terminology (CPT)
|
Current Procedural Terminology (CPT): A list of descriptive terms and identifying codes
for medical, surgical, and diagnostic services and procedures. Provides a uniform language
for reporting and billing purposes.
|