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| National Accounts |
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Large Group accounts that have employees in more than one geographic area that are covered through a single national contract for health Coverage. Contrast with large local groups.
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| National Association of Insurance Commissioners (NAIC) |
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A national organization of state officials charged with regulating insurance. NAIC was formed to promote national uniformity in insurance regulations.
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| National Committee for Quality Assurance (NCQA) |
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A national group responsible for devising and monitoring Quality measurements and standards for health care entities
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| National Drug Code (NDC) |
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Numerical coding system for drug identification. NDC numbers are assigned by the Food and Drug Administration (FDA) and are typically used to bill payers for the drugs provided to health care beneficiaries.
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| National Fraternal Congress of America |
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A federation of fraternal Benefit societies.
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| National Health Insurance |
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Any system of socialized insurance Benefits covering all or nearly all of the citizens of a country, established by its federal law, administered by its federal government, and supported or subsidized by taxation.
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| National Practitioner Data Bank (NPDB) |
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A database maintained by the federal government that contains information on physicians and other medical practitioners against whom medical malpractice claims have been settled or other disciplinary actions have been taken.
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| Negotiated Rate |
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The amount negotiated between the Insurance Carrier, or on behalf of the Insurance Carrier, and the Health Care Practitioner, facility or supplier as total payment for the services or supplies provided.
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| Network |
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The group of physicians, Hospitals, and other medical care Providers that a specific Managed Care Plan has contracted with to deliver medical services to its members.
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| Network Manager |
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An organization or entity, designated by the Insurance Carrier, which may administer the Participating Provider Network, and or Participating Provider Pharmacy Network.
The Network Manager's name is shown on the insurance Coverage identification (ID) card.
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| Network Model HMO |
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An HMO that contracts with more than one group practice of physicians or specialty groups.
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| Network Provider |
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Any Health Care Practitioner, facility or supplier belonging to the Health Care Provider Network including, but not limited to, the following:
1. Participating Providers.
2. Designated Specialty Provider.
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| Network Retail Pharmacy |
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A Network retail pharmacy is a pharmacy that's part of a group of pharmacies chosen by a prescription drug plan to provide pharmacy care to its Members at a lower cost.
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| Newborns' And Mothers' Health Protection Act (NMHPA) |
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A federal law which mandates that Coverage for Hospital stays for childbirth cannot generally be less than 48 hours for normal deliveries or 96 hours for cesarean births.
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| Newspaper Policy |
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A form of Limited Health Insurance (HI) often sold by newspapers to build or conserve circulation.
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| NMHPA |
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See Newborns' And Mothers' Health Protection Act (NMHPA).
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| No Balance Billing Provision |
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A Provider contract clause which states that the Provider agrees to accept the amount the plan pays for medical services as payment in full and not to bill plan Members for additional amounts (except for Copayments, Coinsurance, and Deductibles).
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| Noncancellable ("Non-Can") |
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A contract of Health Insurance (HI) that the Insured has a right to continue in force by payment of Premiums, as set forth in the contract, for a substantial period of time, also as set forth in the contract. During that period of time, the insurer has no right to make any change in any provision of the contract. The NAIC recommends that the term "noncancellable" not be permitted to be used to designate any form that is not renewable to at least age 50 or for at least five years if issued after age 44. Note that this is in contrast to Guaranteed Renewable, on which the Premium may be increased by classes. The Premium for noncancellable policies must remain as stated in the Policy at the time of issue. Contrast with Guaranteed Renewable.
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| Noncancellable Policy |
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A Policy that guarantees you can receive insurance, as long as you pay the Premium. It is also called a Guaranteed Renewable policy.
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| Non-disabling Injury |
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An Injury that does not qualify the Insured for total or Partial Disability Benefits. A Disability Income Policy may contain a provision for a small Benefit in the case of such an Injury, including medical costs of up to 25% or 50% of one month's Disability Benefit payment.
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| Nonduplication of Benefits |
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A provision in some Health Insurance (HI) policies specifying that Benefits will not be paid for amounts reimbursed by others. In Group Insurance, this is usually called Coordination of Benefits (COB).
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| Non-Formulary Drugs |
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Non-formulary drugs are prescription drugs that aren't included on a prescription drug plan's Formulary - or list of approved drugs.
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| Non-Group Market |
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A market segment that consists of customers who are covered under an Individual Contract for health Coverage or enrolled in a government program.
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| Non-Maleficence |
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An ethical principle which, when applied to Managed Care, states that Managed Care Organization (MCO)s and their Providers are obligated not to harm their members.
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| Nonoccupational Insurance |
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See Unemployment Compensation Disability Insurance (UCD).
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| Non-Occupational Policy |
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A Policy or provision of a Policy which excludes accidents occurring on the job, when such employment is covered by Workers' Compensation.
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| Nonparticipating Provider |
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(1) A Provider who has not signed a contract with a Health Plan. (2) A medical or Health Care Provider who is not certified to participate in theMedicare program.
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| Non-Participating Provider Deductible |
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See Deductible - Non-Participating Provider.
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| Nonparticipating Provider Indemnity Benefits |
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Coverage where services provided by Nonparticipating Providers are reimbursed under an indemnity basis.
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| Non-Participating Provider Out-of-Pocket Limit |
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See Out-of-Pocket Limit - Non-Participating Provider.
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| Non-Preferred Brand-Name Drugs |
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A non-preferred Brand-name drug is a Prescription Medication that is covered by a prescription drug plan, but will cost a Member more than a preferred Brand-named drug. A non-preferred Brand-name drug is in a higher cost Formulary tier than a Preferred Brand Drugs.
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| Nonprofit Insurers |
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Insurers organized under special state laws, usually exempting them from some taxes imposed on regular insurers, to supply Medical Expense Reimbursement Insurance, usually on a service basis. "Blue" plans (Blue Cross and Blue Shield) in most states are an example.
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| Nonrenewable |
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An insurance Policy that cannot be renewed or continued after its expiration date.
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| Non-Renewal |
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The termination of the insurance contract by electing not to renew the Policy at the anniversary date.
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| NPDB |
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See National Practitioner Data Bank (NPDB).
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| Nurse Fees |
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A provision in a medical expense reimbursement Policy calling for reimbursement for the fees of nurses other than those employed by the Hospital.
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| Nursing Home |
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A licensed facility which provides general nursing care to those who are chronically ill or unable to take care of necessary daily living needs. May also be referred to as a Long Term Care (LTC) facility.
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