Glossary of Insurance Terms

S

Secondary payer

An insurance policy, plan, or program that pays second on a claim for medical care. This could be Medicare, Medicaid, or other health insurance depending on the situation.

Selective screening

Accepting the best risks and declining the others - forces other insurers to practice selective screening or suffer poor loss experience.

Self-insured plan

An employer who offers health insurance to its employees, with the benefits paid for entirely by the employer. Self-insured plans are exempt from regulation by state laws, but are subject to certain federal requirements under ERISA.

Service area

The area where the plan accepts enrollees and, for managed care plans, where the plan has contracted providers that you are required to use. Most coordinated care plans operate in a limited geographic area known as a service area. It is usually stated as county or zip code of operation.

Settlement options

Methods for payment of the value of a policy. An insurance company can select one of three options in settlement of a loss (1) make a cash payment; (2) take possession of damaged or destroyed property and replace it with property of like kind and quality, or (3) repair the property so that it is restored to its structural condition prior to the loss and return the repaired property to the insured. Usually insurance companies settle losses by a cash payment to the insured.

Skilled nursing care

Medically necessary care that can only be provided by, or under the supervision of, skilled, licensed, medical professionals such as registered nurses or professional therapists. All skilled services require a physician's order. Medicare's definition is often different from the definitions used in many Medicare supplement and long-term care insurance policies.