Health / Health Insurance Glossary

Grievances: Formal complaints demanding formal resolution by a managed care plan.

Group Health Insurance: Coverage through an employer or other entity that covers all individuals in the group. Read more about group health insurance.

Group Market: A market segment that includes groups of two or more people that enter into a group contract with an MCO under which the MCO provides healthcare coverage to the members of the group.

Group Model HMO: An HMO that contracts with a multi-specialty group of physicians who are employees of the group practice. Also known as a group practice model HMO.

Group Practice Without Walls (GPWW): A legal entity that combines multiple independent physician practices under one umbrella organization and performs certain business operations for the member practices or arranges for these . . . View Full Definition

Guaranteed Issue: An insurance policy provision under which all eligible persons who apply for insurance coverage and who meet certain conditions are automatically issued an insurance policy.

Health Care Decision Counseling: Services, sometimes provided by insurance companies or employers, that help individuals weigh the benefits, risks and costs of medical tests and treatments. Unlike case management, health ca . . . View Full Definition

Health Care Quality Improvement Act (HCQIA): A federal act which exempts hospitals, group practices, and HMOs from certain antitrust provisions as they apply to credentialing and peer review so long as these entities adhere to due proc . . . View Full Definition

Health Care Quality Improvement Program (HCQIP): A program, established by the Balanced Budget Act of 1997, that seeks to improve the quality of care provided to Medicare beneficiaries by requiring Medicare+Choice coordinated care plans to . . . View Full Definition

Health Cooperatives: Health Cooperatives have been proposed in the Senate as an alternative to a proposed government plan or public option. The cooperatives, which would be structured as non-profits and owned by . . . View Full Definition

Health Information Network (HIN): An electronic system that uses telecommunications devices to link various healthcare entities within a geographic region in order to exchange patient, clinical, and financial information in . . . View Full Definition

Health Insurance Portability And Accountability Act (HIPAA): A federal act that protects people who change jobs, are self-employed, or who have pre-existing medical conditions. HIPAA standardizes an approach to the continuation of healthcare benefits . . . View Full Definition

Health Maintenance Organization (HMO): A healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a . . . View Full Definition

Health Maintenance Organizations (Hmos): Health Maintenance Organizations represent 'pre-paid' or 'capitated' insurance plans in which individuals or their employers pay a fixed monthly fee for services, instead of a separate charg . . . View Full Definition

Healthcare Quality: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

HIPAA: A Federal law passed in 1996 that allows persons to qualify immediately for comparable health insurance coverage when they change their employment or relationships. It also creates the autho . . . View Full Definition

HMO Act: 1973 federal law that ensured access for HMOs to the employer-based insurance market.

Hold Harmless Provision: A contract clause which forbids providers from seeking compensation from patients if the health plan fails to compensate the providers because of insolvency or for any other reason.

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