Health Insurance Glossary
- Date of Service:
- The date on which a healthcare service was provided.
- Deductible:
- A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.
- Deductible Carry-over Credit:
- -see, Carry-over Provision
- Department of Health and Human Services:
- A department of the federal government responsible for certain social service functions, such as the administration and supervision of the Medicare program.
- Dependent Coverage:
- Health insurance coverage extended to the spouse and unmarried children of the primary insured member. Certain age restrictions on the coverage of children may apply.
- Designated Mental Health Provider:
- An organization hired by a health insurance plan to provide mental health and/or substance abuse treatment services.
- Drug Formulary:
- A list of prescription medications selected for coverage under a health insurance plan. Drugs may be included on a drug formulary based upon their efficacy, safety and cost-effectiveness. Some health insurance plans may require that patients obtain preauthorization before non-formulary drugs are covered. Other health insurance plans may require that a patient pay a greater share or all of the cost involved in obtaining a non-formulary prescription.
- Drug Maintenance List:
- A list of commonly prescribed drugs intended for patients' ongoing or long-term use.
- Drug Utilization Review (DUR):
- The process by which health insurance companies evaluate or review the use of prescription drugs for appropriateness in the treatment of a patient.
- Durable Medical Equipment (DME):
- Medical equipment used in the course of treatment or home care, including such items as crutches, knee braces, wheelchairs, hospital beds, prostheses, etc.. Coverage levels for DME often differ from coverage levels for office visits and other medical services.
please note, however, that definitions of certain terms may vary across insurance companies.
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