Acronyms for Life, Accident & Health Insurance and Managed Care

Updated Jan 2010

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The following is a list of acronyms commonly used in relation to life, accident and health insurance.

ACD

Accidental Death Benefit

ADA

Americans with Disabilities Act (Federal Act)

AD&D

Accidental Death and Dismemberment

ADB

Accelerated Death Benefit

ADEA

Age Discrimination in Employment Act (Federal Act)

ADL

Activities of Daily Living

ADR

Alternative Dispute Resolution

APL

Automatic Premium Loan

APS

Attending Physician's Statement

ART

Annually Renewable Term (Also YRT—yearly renewable term) Life Insurance

ASO

Administrative Services Only

Cap

Capitation

CFA

Certified Financial Analyst

CFP

Certified Financial Planner

CHAMPUS

Health Insurance Program for Military Personnel (Now TRICARE) (Federal Program)

CHIP

Comprehensive Health Insurance Plan (State Agency)

CLU

Chartered Life Underwriter

CMS

Centers For Medicare & Medicaid Services (Was HCFA) (Federal Agency)

COB

Coordination of Benefits

COC

Certificate of Coverage

COLA

Cost-Of-Living Adjustment

COBRA

Consolidated Omnibus Budget Reconciliation Act (Federal Act)

CPI

Consumer Price Index

CPT

Current Procedural Terminology (Procedure Codes)

CSO

Commissioners Standard Ordinary (Mortality Tables)

DME

Durable Medical Equipment

DO

Doctor of Osteopath

DOB

Date of Birth

DOS

Date of Service

DOL

U.S. Department of Labor (Federal Agency)

DRGs

Diagnostic Related Groups

DX

Diagnosis Code

EAP

Employee Assistance Program

EFT

Electronic Funds Transfer

EOB

Explanation of Benefits

EOI

Evidence of Insurability

EOMB

Explanation of Medicare Benefits

EPO

Exclusive Provider Organization

ERISA

Employee Retirement Income Security Act (Federal Act)

ESRD

End Stage Renal Disease

FCRA

Fair Credit Reporting Act (Federal Act)

FEHBP

Federal Employees Health Benefits Program

FMLA

Family Medical Leave Act (Federal Act)

FPDA

Flexible Premium Deferred Annuity

GI

Guaranteed Insurability Benefit (Life)

GLBA

Gramm-Leach Bliley (Financial Modernization Act) (Federal Act)

GUL

Group Universal Life Insurance

HCFA

Health Care Financing Administration (Now CMS) (Federal Agency)

HCFA-1500

Standardized Physician Billing Form

HIAA

Health Insurance Association of America

HIPAA

Health Insurance Portability and Accountability Act (Federal Act and State Law)

HIPAA CHIP

CHIP plan for uninsurable people at termination of continuation coverage whether it be Illinois continuation or COBRA

HMO

Health Maintenance Organization

ILAHP

Illinois Association of Health Plans

IDEA

Individuals with Disabilities Education Act of 1997 (Federal Act)

ICD-9

International Classification of Diseases (Diagnosis codes)

IME

Independent Medical Exam

IRA

Individual Retirement Account

IPA

Independent Practice Association

JCAHO

Joint Commission on Accreditation of Healthcare Organizations

KIDCARE

Illinois Program for insuring certain children and expectant mothers

LCSW

Licensed Clinical Social Worker

LHSO

Limited Health Service Organization

LTC

Long Term Care

MCO

Managed Care Organization

MSN

Medicare Summary Notice

Medigap

Medicare Supplement Insurance

Medsupp

Medicare Supplement Insurance

MET

Multiple Employer Trust

MEWA

Multiple Employer Welfare Arrangement

MIB

Medical Information Bureau

MIS

Management Information Systems

MSA

Medical Savings Account

MSP

Medicare Second Payer

NAIC

National Association of Insurance Commissioners

NAMCR

National Association of Managed Care Regulators

NCQA

National Committee for Quality Assurance

NICB

National Insurance Crime Bureau

Non-par

Non-participating Provider

OBRA

Omnibus Budget Reconciliation Act of 1993

OCHI

Office of Consumer Health Insurance

OPM

Office of Personnel Management (Federal employee benefits)

OTC

Over the counter

Par

Participating Provider

PCP

Primary Care Physician

PFFS

Private Fee For Service (An alternative form of Medicare)

POA

Power of Attorney

PHO

Physician Hospital Organization

PMPM

Per Member Per Month

POS

Point of Service

PPA

Preferred Provider Arrangement

PPO

Preferred Provider Organization

PWBA

Pension and Welfare Benefits Administration (Federal Agency)

QA

Quality Assurance

QMB

Qualified Medicare Beneficiary

QMCSO

Qualified Medical Child Support Order

RBC

Risk Based Capital

ROC

Review Oversight Committee

RTW

Return to Work (date for disability coverage)

SEC

Securities and Exchange Commission

SEP

Simplified Employee Pension

SHIP

Senior Health Insurance Program

SNF

Skilled Nursing Facility

SPD

Summary Plan Description

SPDA

Single-Premium Deferred Annuity

SPIA

Single-Premium Immediate Annuity

SSDI

Social Security Disability Insurance

TPA

Third Party Administrator

TPPP

Third Party Prescription Program

TRICARE

Health insurance program for military personnel (Was called CHAMPUS) (Federal Program)

UB92

Standardized Hospital Billing Form

U&C, R&C, UCR

Usual and Customary, Reasonable and Customary, Usual Customary and Reasonable

UR

Utilization Review

URAC

Utilization Review Accreditation Commission

VHSP

Voluntary Health Service Plan

VSP

Viatical Settlement Provider

WHCRA

Women's Health and Cancer Rights Act

WP

Waiver of Premium For Disability Benefit

WPHCP

Women's Principal Health Care Provider

YTD

Year-To-Date

YRT

Yearly Renewable Term Insurance (Also ART—annually renewable term ins)

For More Information

Call our Consumer Services Section at (312) 814-2427 or our Office of Consumer Health Toll Free at (877) 527-9431 or visit us on our website at http://insurance.illinois.gov