Glossary

A

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
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
Amendment

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
ASO

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
Audit

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