Glossary

Behavioral care refers to treatment for a mental illness or disorder, a functional nervous disorder, or addiction.  Behavioral care is also commonly called psychoanalytic care or psychiatric care.

A benefit is a product or service that a plan pays for in part or in whole.

A benefit booklet is the summary plan description (SPD) for a self-funded plan.

A benefit year refers to the fiscal 12-month period during which yearly plan design features such as the deductible, out-of-pocket maximum, and specific benefit maximums accumulate.  A benefit year is often, but not always, January 1 through December 31.

A broker or an agent is an authorized representative of a group who solicits insurance contracts and services on the group's behalf even though an insurance company or third-party administrator (TPA) may pay the broker or agent commissions.

Bundling is a method by which two or more medical services are combined for payment.

A business associate is a third party that acts on behalf of a covered entity by performing a function or activity that HIPAA's Administrative Simplification rules regulate or that provides certain services (e.g., legal or consulting services) that involve the use or disclosure of individually identifiable health information.