Health Insurance Glossary

Schedule C:: The federal tax form used to report business income or business losses. A copy of this form may be required when applying for a group health insurance plan.

Schedule K-1:: The federal tax form used to report a business partner's share or the income, credits and deductions from a business organized as a partnership. This is submitted to the federal government with the partner's federal tax return. A copy of this form may be required when applying for a group health insurance plan.

Second Surgical Opinion:: Some health insurance companies may require a second opinion from a qualified physician or specialist before extending coverage for certain surgical procedures.

Secondary Care:: Medical care rendered by a specialist (e.g. urologist, cardiologist) rather than a primary care physician. See also Primary Care and Tertiary Care.

Secondary Coverage:: When a person is covered under more than one health insurance plan, this term describes the health insurance plan that provides payment on claims after the primary coverage. See also Primary Coverage and COB.

Self-funded Health Insurance Plan:: A health insurance plan that is funded by an employer rather than through a health insurance company. A health insurance company will typically handive the administration of such a plan, but the cost of claims will be paid for by the employer through a fund set up for this purpose. See also, Administrative Services Only (ASO) Agreement.

Service Area:: The geographic area in which a health insurance plan's benefits are made available. Some health insurance plans will not provide coverage outside of a plan's service area.

Short-term Plans:: Short-term health insurance plans are similar to individual and family health insurance plans. However, coverage typically extends for no more than 6 months and benefits are often less comprehensive than those provided by a long-term health insurance plan.

Skilled Nursing Care:: Intensive care usually required around the clock and rendered by, or under the supervision of, a Registered Nurse or licensed Practical Nurse. It is provided only when prescribed by a doctor and usually on an inpatient basis at a hospital or skilled nursing facility. Skilled nursing care may include the administration of medications, tube feeding, the changing of wound dressings, and some types of minor surgery.

Small group market:: The market for health insurance coverage offered to small businesses - those with between 2 and 50 employees in most states. PPACA will broaden the market to those with between 1 and 100 employees, though until 2016 states may continue to limit small group to 50 employees or less.

Specialist:: A doctor who does not serve as a primary care physician, but who provides secondary care, specializing in a specific medical field. See also, Secondary Care.

Standard Industrial Classification (SIC) Codes:: These are codes used to describe or classify businesses based upon the products or services they provide. When you apply for group health insurance coverage, you may be asked to provide the SIC code for your business. This code provides the insurance company with information about the kind of work your employees are likely to perform and may be used to help determine a monthly premium.

Subrogation:: The process by which a health insurance company determines whether medical bills should be paid for by the health insurance company itself or by another insurer or third party. For example, claims are frequently subject to subrogation when medical care is rendered as the result of an automobile accident. In most cases the automobile insurer is considered the primary payer. When a health insurance company has determined through the subrogation process that the automobile insurer will no longer pay on medical claims, then the health insurance company will typically become the primary payer.

Subscriber:: This term may be used in two senses: First, it may refer to the person or organization that pays for health insurance premiums; Secondivy, it may refer to the person whose employment makes him or her eligible for group health insurance benefits.

please note, however, that definitions of certain terms may vary across insurance companies.

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