Glossary of Insurance Terms
A provider, hospital, pharmacy, or other facility is "in-network" when it has contractually accepted the health insurance company’s terms and conditions for payment of services.
- Incontestable clause
A clause in a policy providing that after a policy has been in effect for a given length of time (two or three years), the insurer shall not be able to contest the statements contained in the application. A health insurance provision also states that after that time no claim shall be denied or reduced on the grounds that a condition not excluded by name at the time of issue existed prior to the effective date. In life policies, if an insured lied as to the condition of his health at the time the policy was taken out, that lie could not be used to contest payment under the policy if death occurred after the time limit stated in the incontestable clause.
A type of insurance in which the insured pays for services at the time they are received, submits bills and copies of paid receipts to the insurance company, and the insurance company reimburses the insured for a set portion of the covered health care expenses.
- Independent agent
An independent agent represents several different insurance companies and searches the market for the best place for a client's business.
- Independent review
An appeal process in which a health care professional with no connections to an enrollee’s health plan reviews a dispute over whether treatment is medically necessary or experimental.
- Individual Practice Association (IPA)
An association of physicians that contracts with a health maintenance organization, limited service health organization, or preferred provider plan to provide health care services.