Health / Health Insurance Glossary

In-Network: Providers or health care facilities which are part of a health plan's network of providers with which it has negoiated a discount. Insured individuals usually pay less when using an in-netwo . . . View Full Definition

Incorporation By Reference: The method of making a document a part of a contract by referring to it in the body of the contract.

Indemnity Health Plan: Indemnity health insurance plans are also called 'fee-for-service.' These are the types of plans that primarily existed before the rise of HMOs, IPAs, and PPOs. With indemnity plans, the ind . . . View Full Definition

Indemnity Wraparound Policy: An out-of-plan product that an HMO offers through an agreement with an insurance company.

Independent Agents: Agents that represent the products of several health plans or insurers.

Independent Practice Association (IPA): An organization comprised of individual physicians or physicians in small group practices that contracts with MCOs on behalf of its member physicians to provide healthcare services.

Independent Practice Associations: IPAs are similar to HMOs, except that individuals receive care in a physician's own office, rather than in an HMO facility.

Individual Health Insurance: Health insurance coverage on an individual, not group, basis. The premium is usually higher for an individual health insurance plan than for a group policy, but you may not qualify for a gro . . . View Full Definition

Individual Market: A market segment composed of customers not eligible for Medicare or Medicaid who are covered under an individual contract for health coverage.

Individual Stop-Loss Coverage: 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.

Integrated Delivery System (IDS): 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.

Integration: 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 provi . . . View Full Definition

IPA Model HMO: A health maintenance organization which contracts with one or more associations of physicians in independent practice who agree to provide medical services to HMO members.

Joint Venture: A type of partial structural integration in which one or more separate organizations combine resources to achieve a stated objective. The participating companies share ownership of the ventu . . . View Full Definition

Large Group: A large pool of individuals for which health coverage is provided by the group sponsor. A large group may be defined as more than 250, 500, 1,000, or some other number of members, depending . . . View Full Definition

Lifetime Maximum Benefit: (or Maximum Lifetime Benefit) the maximum amount a health plan will pay in benefits to an insured individual during that individual's lifetime.

Lifetime Maximum Benefit Amount: The maximum dollar amount set by an MCO that limits the total amount the plan must pay for all healthcare services provided to a subscriber in the sub-scriber's lifetime.

Limitations: a limit on the amount of benefits paid out for a particular covered expense, as disclosed on the Certificate of Insurance.

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