Glossary
The term "actively at work" describes an employee's expenditure of time and energy in the service of an employer. A participant is deemed actively at work on each day of a regular paid vacation and on a regular non-working day on which the participant is not totally disabled if the participant was actively at work on the last proceeding regular working day.
ASO refers to an arrangement between an insurance company or third-party administrator (TPA) and a self-funded client in which the insurance company or TPA performs administrative services (e.g., processing claims and handling paperwork) for a group. However, the client assumes financial risk for the claims.
Advanced funding is a provision that allows a stop-loss carrier to pre-fund a claim that has met the specific deductible.
An agent of record is the person who a group designates in writing to assist with controlling the group plan and authorizing group information.
An aggregate deductible is the dollar level at which aggregate stop-loss coverage takes effect. It is also called the trigger point or attachment point.
Aggregate stop-loss coverage is a type of excess-loss coverage. It protects the policyholder (i.e., the employer) from total claims paid on behalf of the entire group that exceed a predetermined amount (i.e., the aggregate deductible) during a contract period.
An ambulatory surgical facility is an establishment that exclusively offers outpatient surgical services to patients.
An amendment is a written statement that modifies a plan document, and it has the same legal power as the original document when it is properly signed by the plan sponsor.
An annual open enrollment period is an interval of time each year during which participants make elections under a health plan. The employer determines the beginning and ending dates of each open enrollment period and communicates them to participants.
An annual report is the Form 5500.
The term "ASO" means administrative services only.
An attachment point is the aggregate deductible.
An audit is a retrospective review of a provider's charges to ensure that all billed services were provided, that the charges for these services were accurate, and that the fees for these services were reasonable.