GLOSSARY OF TERMS
AHG: American Health Group, a third party Care Management company
BUCA: Blue Cross Blue Shield, United Healthcare, Cigna & Aetna
Captive: Generally defined as an insurance company that is wholly owned and controlled by its insureds; its primary purpose is to insure the risks of its owners, and its insureds benefit from the captive insurer’s underwriting profits.
TAAQHealth: The technology and product development company for PEACEPlan.
Claims funds: Portion of premium set aside to pay medical claims.
CM: Care Management
Coinsurance: The percentage you pay on a claim after the deducible has been met.
Deductible: The amount you pay before any coinsurance is applied.
DM: Disease Management
Level-funded: Opportunity for employer to retain excess claim funds
Member: Participant in Health Plan
Networks: Provider discounts such as Primary Care Physicians, Hospitals, Labs …
PBM: Transparent Pharmacy Benefit Manager
PCP: Primary Care Physician
Stop-Loss: (sometimes referred to as Reinsurance): Provides protection against catastrophic or unpredictable losses
TPA: Third Party Administrator
UR: Utilization Review