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Glossary Of Terms |
Please Note: This information is a general reference tool. All terms, conditions and amounts may not be applicable to your benefit plan. Please refer to your Plan Document for a complete listing of terms, conditions, coverage and exclusions of your benefit plan.
Terms Beginning with the Letter "H"
Health Care Reimbursement Plan means the plan of benefits which provides reimbursement for medical expenses incurred by a participant or dependent.
Health Maintenance Organization (HMO): A type of managed care plan. With a HMO, you pick a primary doctor who manages all of the medical services you receive. HMOs cover the costs of many preventative services.
Health Status-Related Factor means health information, including:
- Health status;
- Medical conditions (including both physical and mental illness);
- Claims experience;
- Receipt of healthcare;
- Medical history;
- Genetic Information;
- Evidence of insurability (including conditions arising out of acts of domestic violence); or
- Disability
HIPAA means the Health Insurance Portability and Accountability Act of 1996.
Home Health Care Agency is an organization that meets all of these tests: its main function is to provide Home Health Care Services and Supplies; it is federally certified as a Home Health Care Agency; and it is licensed by the state in which it is located, if licensing is required.
Home Health Care Plan must meet these tests: it must be a formal written plan made by the patient's attending Physician which is reviewed at least every 30 days; it must state the diagnosis; it must certify that the Home Health Care is in place of Hospital confinement; and it must specify the type and extent of Home Health Care required for the treatment of the patient.
Home Health Care Services and Supplies include: part‑time or intermittent nursing care by or under the supervision of a registered nurse (R.N.); part‑time or intermittent home health aide services provided through a Home Health Care Agency (this does not include general housekeeping services); physical, occupational and speech therapy; medical supplies; and laboratory services by or on behalf of the Hospital.
Hospice Agency is an organization whose main function is to provide Hospice Care Services and Supplies and it is licensed by the state in which it is located, if licensing is required.
Hospice Care Plan is a plan of terminal patient care that is established and conducted by a Hospice Agency and supervised by a Physician.
Hospice Care Services and Supplies are those provided through a Hospice Agency and under a Hospice Care Plan and include inpatient care in a Hospice Unit or other licensed facility, home care, and family counseling during the bereavement period.
Hospice Unit is a facility or separate Hospital Unit that provides treatment under a Hospice Care Plan and admits at least two unrelated persons who are expected to die within six months.
Hospital is an institution which is engaged primarily in providing medical care and treatment of sick and injured persons on an inpatient basis at the patient's expense and which fully meets these tests: it is accredited as a Hospital by the Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association; it is approved by Medicare as a Hospital; it maintains diagnostic and therapeutic facilities on the premises for surgical and medical diagnosis and treatment of sick and injured persons by or under the supervision of a staff of Physicians; it continuously provides on the premises 24-hour a day nursing services by or under the supervision of registered nurses (R.N.s); and it is operated continuously with organized facilities for operative surgery on the premises.
The definition of "Hospital" shall be expanded to include the following:
- A facility operating legally as a psychiatric Hospital or residential treatment facility for mental health and licensed as such by the state in which the facility operates.
- A facility operating primarily for the treatment of Substance Abuse if it meets these tests: maintains permanent and full‑time facilities for bed care and full‑time confinement of at least 15 resident patients; has a Physician in regular attendance; continuously provides 24‑hour a day nursing service by a registered nurse (R.N.); has a full‑time psychiatrist or psychologist on the staff; and is primarily engaged in providing diagnostic and therapeutic services and facilities for treatment of Substance Abuse.
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