GLOSSARY OF HEALTH INSURANCE TERMS

F

Fail First Requirements (also called Step Therapy) — drug plans may require an enrollee to try one drug before the plan will pay for another drug. Step therapy aims to control costs by requiring that enrollees use more common drugs which are usually less expensive. The process of beginning drug therapy for a medical condition with the most cost-effective and safest drug therapy and progressing to costlier or riskier therapy is called Step therapy or Fail First Requirement. Progression to a new medication is based on the failure of the former medication to relieve or cure symptoms — why it is called ''fail first.'' Physicians and drug plans may disagree on the proper Step Therapy and patients are encouraged to become knowledgeable and decisive in agreeing to protocols. Also called ''step protocol.''

Family Practitioner — a physician, a generalist who cares for the whole family regardless of age.

Fee Disclosure — physicians and caregivers discussing their charges with patients before treatment.

Fee-For-Service (FFS) — traditional method of payment for health care services where specific payment is made for specific services rendered. Usually people speak of this in contrast to capitation, diagnostic-related group (DRG) or per diem discounted rates, none of which are similar to the traditional fee for service method of reimbursement. Under a fee-for-service payment system, expenditures increase if the fees themselves increase, if more units of service are provided, or if more expensive services are substituted for less expensive ones.

Fiduciary — indicates the relationship of trust and confidence where one person (the fiduciary) holds or controls property for the benefit of another person. For example, the relationship between a trustee and the beneficiaries of the trust.

First Dollar Coverage — insurance coverage with no front-end deductible where coverage begins with the first dollar of expense incurred by the insured for any covered benefit.

Flat Fee-Per-Case — a flat fee paid for a client's treatment based on their diagnosis and/or presenting problem. For this fee, the provider covers all of the services the client requires for a specific period of time.

Flexible Benefit Plan — a program offered by some employers in which employees may choose among a number of health care benefit options.

Flexible Spending Account — a plan that gives employees the opportunity to set aside pre-tax funds for the reimbursement of eligible tax-favored welfare benefits under Section 125 of the IRS tax code. Two plans are available, health care and dependent day care. Also called Reimbursement Accounts.

Formulary (prescription drug) — a listing of prescription medications that will be covered by a plan or insurance contract that often fosters substitution of generic or therapeutic equivalents on a cost-effective basis. Organizations often develop a formulary under the leadership of a pharmacy and therapeutics committee. When used by hospitals or clinics, a formulary is intended as a recommendation usually and not considered a requirement.