- Actively at Work
The term "actively at work" describes an employee's expenditure of time and energy in the service of an employer. A participant is deemed actively at work on each day of a regular paid vacation and on a regular non-working day on which the participant is not totally disabled if the participant was actively at work on the last proceeding regular working day.
- Administrative Services Only — ASO
ASO refers to an arrangement between an insurance company or third-party administrator (TPA) and a self-funded client in which the insurance company or TPA performs administrative services (e.g., processing claims and handling paperwork) for a group. However, the client assumes financial risk for the claims.
- Related Terms: Third-Party Administrator
- Advanced Funding
Advanced funding is a provision that allows a stop-loss carrier to pre-fund a claim that has met the specific deductible.
- Related Terms: Specific Deductible, Specific Stop-Loss, Stop-Loss Coverage
- Affiliation Period
An affiliation period is a period of time that must expire before health insurance coverage that is provided by a small employer carrier becomes effective, and during which time the plan is not required to provide benefits. An affiliation period is similar to a waiting period, which is not allowed for groups of less than 50 employees under the Small Employer Group Health Coverage Act because a waiting period is essentially a pre-existing condition limitation. The carrier-imposed affiliation period can be no longer than 60 days for new enrollees and 90 days for late enrollees.
- Related Terms: Pre-Existing Condition, Small Employer Group Health Coverage Act, Waiting Period
- Agent of Record
- An agent of record is the person who a group designates in writing to assist with controlling the group plan and authorizing group information.
- Related Terms: Broker/Agent
- Aggregate Deductible
An aggregate deductible is the dollar level at which aggregate stop-loss coverage takes effect. It is also called the trigger point or attachment point.
- Related Terms: Aggregate Stop-Loss Coverage, Deductible, Stop-Loss Coverage
- Aggregate Stop-Loss Coverage
Aggregate stop-loss coverage is a type of excess-loss coverage. It protects the policyholder (i.e., the employer) from total claims paid on behalf of the entire group that exceed a predetermined amount (i.e., the aggregate deductible) during a contract period.
- Related Terms: Aggregate Deductible, Stop-Loss Coverage
- Ambulatory Surgical Facility
- An ambulatory surgical facility is an establishment that exclusively offers outpatient surgical services to patients.
- Related Terms: Outpatient
An amendment is a written statement that modifies a plan document, and it has the same legal power as the original document when it is properly signed by the plan sponsor.
- Related Terms: Plan Document, Plan Sponsor, Summary of Material Modifications, Summary Plan Description
- Annual Open Enrollment Period
An annual open enrollment period is an interval of time each year during which participants make elections under a health plan. The employer determines the beginning and ending dates of each open enrollment period and communicates them to participants.
- Related Terms: Enrollment, Special Enrollment Period
- Annual Report
- An annual report is the Form 5500.
- Related Terms: Form 5500
- The term "ASO" means administrative services only.
- Related Terms: Administrative Services Only
- Attachment Point
- An attachment point is the aggregate deductible.
- Related Terms: Aggregate Deductible
An audit is a retrospective review of a provider's charges to ensure that all billed services were provided, that the charges for these services were accurate, and that the fees for these services were reasonable.
- Related Terms: Fee for Service