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| IBNR Claims |
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Incurred but not reported Claims.
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| Identification Card |
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A card given to each person covered under the plan which identifies him or her as being eligible for Benefits.
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| Identification of Benefits |
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A provision that the cost of putting a disabled Insured in touch with and in the care of relatives will be reimbursed, usually up to a maximum amount.
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| IDS |
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See Integrated Delivery System (IDS).
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| IEP or "Initial Enrollment Period" |
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The IEP provides the initial opportunity for existing Medicare beneficiaries to enroll into the Medicare Part D plans. Please note, for those persons who had already qualified for Medicare, the IEP also acted as the first AEP or Annual Election Period (see below). If you enrolled in the IEP, you should have received Coverage beginning the first of the year (if you enrolled in the previous year) or the first day of the month after your Enrollment. For those persons who are just turning 65 or just becoming eligible for Medicare, the Initial Enrollment Period (IEP) is a seven (7) month period that extends three (3) months before the month when a person reaches 65, plus the month where the person turns 65, plus the three (3) month period after the person turns 65. (Please note this is the same 7 month period during which a Beneficiary can also enroll in the Medicare Part B program). If you enrolled in the months before turning 65, your Part D policy begins the first day of your birthday month. If you enrolled during or after your birthday month, your Part D plan begins the first day of the next month. An eligible Medicare Part D Beneficiary who did not enroll during their IEP now face a life-time monthly premium penalty. Related to this word are AEP, OEP, and SEP.
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| Immediate Family Member |
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An Immediate Family Member is:
1. You or Your spouse; or
2. The children, brothers, or sisters and parents of either You or Your spouse; or
3. The spouses of the children, brothers and sisters of You and Your spouse; or
4. Anyone with whom a Covered Person has a relationship based on a legal guardianship.
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| Impaired Risk |
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An insurance applicant who has pre-existing poor health or is in substandard physical condition, is engaged in dangerous activities, or has a hazardous occupation. Incurral Date
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| In-Area Services |
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Services which are provided within the "authorized" Service Area as designated in the plan.
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| Incorporation By Reference |
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The method of making a document a part of a contract by referring to it in the body of the contract.
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| Incur or Incurred |
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The date services are provided or supplies are received.
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| Indemnity Health Plan |
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Indemnity Health Insurance (HI) plans are also called "Fee-for-Service." These are the types of plans that primarily existed before the rise of HMOs and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the Health Plan pays the other percentage. For example, an individual might pay 20% for services and the insurance company pays 80%. The fees for services are defined by the Health Care Providers and vary from physician to physician and Hospital to Hospital.
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| Indemnity Wraparound Policy |
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An Out-Of-Plan product that an HMO offers through an agreement with an insurance company.
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| Independent Agents |
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Agents that represent the products of several Health Plans or insurers.
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| Independent Practice Associations (IPA) |
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An IPA is a type of HMO in which care is provided by independent physicians who contract with the HMO. This contrasts with the "Staff Model" HMO, in physicians are employees of the HMO.
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| Individual Contract |
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A contract made with an individual that covers that individual and perhaps also specified members of his family for Benefits as described in the Policy.
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| Individual Deductible |
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See Deductible - Individual.
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| Individual Health Insurance |
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Health Insurance (HI) Coverage on an individual, not group, basis.
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| Individual Market |
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A market segment composed of customers not eligible forMedicare orMedicaid who are covered under an Individual Contract for health Coverage.
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| Individual Out-of-Pocket Limit |
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See Out-of-Pocket Limit - Individual.
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| Individual Practice Association (IPA) Model HMO |
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A situation where an individual practice association is contracted with to provide health care services. The individual practice association contracts with individual physicians or groups of physicians for their services.
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| Individual Stop-Loss Coverage |
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A type of Stop-Loss Insurance that provides Benefits for Claims on an individual that exceed a stated amount in a given period. Also known as Specific Stop-Loss Coverage.
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| Inflation Factor |
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A Premium loading to provide for future increases in medical costs and loss payments resulting from inflation.
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| Inflation Protection |
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Provisions in a Health Insurance (HI) Policy that increase Benefit Levels to account for anticipated increases in the cost of covered services.
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| In-Force Business |
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Life or Health Insurance (HI) for which Premiums are being paid or for which Premiums have been fully paid. The term refers to the total face amount of a Life insurer's portfolio of business. In Health Insurance (HI) it refers to the total Premium volume of an insurer's portfolio of business.
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| Initial Coverage Limit |
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Amount you pay for prescription drug, with a PDP or an MA-PD, after you have paid the annual Deductible (if applicable) and until the total covered prescription drug costs paid by you and the plan add up to $2930. |
| Initial Eligibility Period |
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The time period during which prospective Members can apply for Coverage without providing Evidence of Insurability.
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| Injury |
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Accidental bodily damage, independent of all other causes, occurring unexpectedly and unintentionally.
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| In-network |
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Providers or health care facilities which are part of a Health Plan's Network Providers with which it has negoiated a discount. Insured individuals usually pay less when using an In-network Provider, because those Networks provide services at lower cost to the insurance companies with which they have contracts.
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| Inpatient |
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Admitted to an Acute Behavioral Health Inpatient Facility, an Acute Medical Facility (Hospital) or other licensed facility for a stay of at least 24 hours for which a charge is Incurred for room and board or observation.
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| Inpatient Care |
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Health care that you get when you stay overnight in a hospital.
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| Inside Limits |
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Limits placed on Hospital expense Benefits which modify Benefits from the overall maximums listed in the Policy. An inside limit when applied to room and board, limits the Benefit to not only a maximum amount payable, but also limits the number of days the Benefit will be paid.
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| Insurance Carrier |
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The insurance company offering the insurance Coverage or its Administrator. Also see Carrier.
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| Insurance In Force |
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The annual Premium payable on current contracts of insurance.
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| Insured |
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A person who has obtained Health Insurance (HI) Coverage under a Health Insurance (HI) plan
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| Integrated Deductible |
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See Deductible - Integrated.
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| Integrated Delivery System (IDS) |
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A Provider organization that is fully integrated operationally and clinically to provide a full range of healthcare services, including physician services, Hospital services, and Ancillary Services.
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| Integrated LTC Rider |
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A LTC Rider which is added to a life insurance Policy whereby LTC Benefits paid will reduce the life insurance policy's Benefits. LTC Benefits are Dependent on the life insurance Benefits available.
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| Integration |
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For Provider organizations, the unification of two or more previously separate Providers under common ownership or control, or the combination of the business operations of two or more Providers that were previously carried out separately and independently.
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| Intensive Outpatient Behavioral Health Program |
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See Behavioral Health Program - Outpatient, Intensive.
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| Intentional Injury |
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An Injury resulting from an act, the doer of which had as his intent, inflicting Injury. In an accident insurance contract, an intentionally Self-Inflicted Injury is not covered (because it is not an accident). In general, an Intentional Injury inflicted on the Insured are covered (assuming no collusion).
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| Intermediate Care |
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A level of care associated with a Skilled Nursing Facility which provides nursing care under the supervision of physicians or a Registered Nurse (RN). The care provided is a step down from the degree of care described as Skilled Nursing Care.
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| Intermediate Care Facility |
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A facility licensed by the state, which provides nursing care to persons who do not require the degree of care which a Hospital or Skilled Nursing Facility provides.
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| Intermediate Disability |
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See Temporary Partial Disability and Permanent Partial Disability.
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| Intermediate Report |
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A Claim report on the condition of a continuing disability.
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| International Association of Health Underwriters |
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An association of agents and related personnel on the Health Insurance (HI) business.
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| International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) |
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Coding system maintained by the National Center for Health Statistics and the Centers for Medicare and Medicaid Services (CMS) . This coding system differentiates diagnostic conditions and is used by Hospitals, governments, Health Insurance (HI) plans, and Health Care Providers around the world.
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| Invalidity |
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Sickness.
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| Investigational or Experimental Services |
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See Experimental or Investigational Services.
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| IPA |
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See Independent Practice Associations (IPA).
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| IPA Model HMO |
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A Health Maintenance Organization (HMO) which contracts with one or more associations of physicians in independent practice who agree to provide medical services to HMO members.
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