Stop-Loss Insurance Glossary

Your comprehensive, searchable guide to stop-loss insurance terminology

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Stop-Loss Insurance Glossary

Actuarial

Administrative Services Only (ASO)

Advanced Funding

Affordable Care Act (ACA)

Aggregate Stop-Loss

Attachment Point

Average Wholesale Price (AWP)

Back-Billing

Balance Billing

Beneficiary

Brand-Name Drugs

Business Associate

Captive Insurance

Case Management

Cell Therapy

Claims

Coinsurance

Concurrent Review

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Consumer-Directed Health Plan (CDHP)

Continuation Coverage

Copayment (Copay)

Cost-Sharing

Covered Entity

Credibility

Deductible

Deductible (Member)

Dependent Coverage

Disease Management

Employee Retirement Income Security Act (ERISA)

EPO (Exclusive Provider Organization)

ERISA Preemption

Essential Health Benefits (EHBs)

Expected Claims

Explanation of Benefits (EOB)

Fiduciary

Fiduciary Responsibility

Fixed Costs

Flexible Spending Account (FSA)

Formulary

Fully-Insured Plan

Gene Therapy

Generic Drugs

Generic Substitution Rate (GSR)

Group Captive

Health Insurance Portability and Accountability Act (HIPAA)

Health Reimbursement Arrangement (HRA)

Health Savings Account (HSA)

High-Cost Claimant (HCC)

High-Deductible Health Plan (HDHP)

Highly Compensated Employee (HCE)

HMO (Health Maintenance Organization)

In-Network

Incurred But Not Paid (IBNP)

Incurred But Not Reported (IBNR)

Individual Stop-Loss (ISL)

Key Employee

Laser

Level-Funded Plan

MAC Effective Rate (MER)

Maximum Allowable Cost (MAC)

Medical Necessity

Medication Possession Ratio (MPR)

Medication Therapy Management (MTM)

Minimum Premium Plan (MPP)

Navigation Services

No Surprises Act

Nondiscrimination Testing

Out-of-Network

Out-of-Pocket Maximum (OOPM)

P&T Committee

Pass-Through Pricing

Pharmacogenomics (PGx)

Pharmacy Benefit Manager (PBM)

Plan Administrator

Plan Document

Plan Mirroring

Plan Participant

Plan Sponsor