The insurance industry is notorious for using a lot of acronyms and interchangeable terms.
In case you get lost in my posts, here are some basic definitions used in athletic insurance
Accident Medical Expense (AME)
The expense or cost that is incurred following an accidental injury
Accidental Death & Dismemberment (AD&D)
AD&D coverage is typically included in athletic insurance policies and covers the unintentional death or dismemberment of the insured. Dismemberment usually includes the loss, or loss of use, of critical body parts or functions (limbs, eyesight, speech, and hearing)
Aggregate Deductible
the total (or aggregate) of all the individual claims incurred during a given policy year. In athletic insurance, the aggregate deductible is set by the insurance carrier and is the portion of an aggregate deductible plan design in which the insured is responsible for before the deductible is met and carrier’s responsibility begins.
Balance Bill
When a medical provider files a claim with primary insurance and then bills the insured for the remaining balance due.
Bind Coverage
The process of notifying the insurance carrier that you are officially accepting an insurance quote. Usually in a written manner.
Benefit Period
The period of time in which the insured athlete has to receive medical treatment following the date of injury. Standard in athletic insurance is 2 years (104 weeks)
Blanket Accident Insurance
Blanket insurance covers a group of people. In athletic insurance, athletes are simply listed by gender and by sport versus by individual names as is the case in non-blanket insurance coverages
Carrier
The insurer, insurance carrier
Claim
A formal request by a policy holder to an insurance carrier for compensation of a covered loss.
Claim Form
The written notice of a claim filed by the policy holder to the insurance carrier
Claims Payer
The company that handles the claims and processes payments on behalf of the insurance carrier. Also referred to as a third-party administrator (TPA)
CMS1500 form
Coinsurance
The portion of a medical bill in which the insured is responsible for, typically referred to as a percentage.
Copay
A fixed amount that the insured is required to pay out-of-pocket, even after the deductible is met
Covered Activities
Defined during the underwriting process to reflect the specific activities that will be covered by the policy. Ex: Training, practice, conditioning and participation in sports or required travel for those activities.
CPT Code
Deductible (specific per claim)- in secondary insurance, the specific deductible is the amount that needs to be paid by primary insurance or out-of-pocket payments before the insurance carrier’s responsibility begins
Effective Dates
The dates in which the coverage is active. In accident insurance, a covered accident must occur while the policy is effective to be covered
Excess Coverage
Insurance that pays secondary (or in excess) to any other, valid and collectible insurance coverage
Exclusion
A specific loss that is not covered by the insurance policy
Expanded Medical
Coverage for wear and tear type injuries like tendinitis, bursitis, etc. Typically an additional rider or an addendum
Explanation of Benefits (EOB)
A statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf
Guest Recruit Coverage
Designed to cover potential student-athletes that are on campus working out or trying out for the team
Hard Waiver
Requirement that all students at the school show proof of health insurance coverage or else they are required to purchase the campus health plan
Health Insurance
Insurance purchased by an individual or as part of a group plan to cover accidents and sickness
Heart & Circulatory Benefit
Designed to cover losses related to the heart and circulatory system that are a direct result of the insured market participation in intercollegiate athletics.
HMO/PPO Denials Coverage
A rider that designates the secondary athletic insurance as primary payer in the event that an athlete’s primary insurance is considered out-of-network or not accepted by the medical provider
In-Network
Initial Treatment Period
Insured Percentage
Insured
Insurer
Itemized Bill
Loss/Losses
Medical Maximum
Out-of-Pocket Maximum
Out-of-Network
Policy
Pre-Authorization
Pre-Existing Conditions
Premium
Proof of Loss
Provider
Provider Agreement
THE ATHLETIC INSURANCE GUY 