A
- Actively at Work
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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
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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.
- Advanced Funding
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Advanced funding is a provision that allows a stop-loss carrier to pre-fund a claim that has met the specific deductible.
- Agent of Record
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An agent of record is the person who a group designates in writing to assist with controlling the group plan and authorizing group information.
- Aggregate Deductible
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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.
- Aggregate Stop-Loss Coverage
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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.
- Ambulatory Surgical Facility
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An ambulatory surgical facility is an establishment that exclusively offers outpatient surgical services to patients.
- Amendment
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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.
- Annual Open Enrollment Period
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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.
- Annual Report
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An annual report is the Form 5500.
- ASO
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The term "ASO" means administrative services only.
- Attachment Point
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An attachment point is the aggregate deductible.
- Audit
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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.