Glossary of Terms

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

Pre-Cert: Pre-Certification

RCI: Regional Care Inc., a third party administrator processing claims and eligibility for PEACEPlan.

SL: Stop-loss

Stop-Loss: (sometimes referred to as Reinsurance): Provides protection against catastrophic or unpredictable losses

TPA: Third Party Administrator

UR: Utilization Review

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