GLOSSARY OF HEALTH INSURANCE TERMS

H

Health Maintenance Organization (HMO) — a prepaid medical group practice plan that provides a comprehensive predetermined medical care benefit package. HMOs emphasize preventive care, early diagnosis and outpatient treatment. The HMO can be sponsored by the government, medical schools, hospitals, employers, labor unions, consumer groups, insurance companies and hospital-medical plans. HMOs are both insurers and providers of health care.

HCFA (Health Care Financing Administration) — the federal agency that oversees all aspects of health financing for Medicare.

HEDIS (Health Plan Employer Data and Information Set) — a core of performance measures designed by participating managed health plans and employers to meet the employers' need to understand the value of their health care benefits and to hold plans accountable for performance. HEDIS is offered under the sponsorship of the National Committee for Quality Assurance (NCQA).

Hematologist — a physician who specializes in blood disorders.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) — a federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. This legislation sets a precedent for Federal involvement in insurance regulation. It sets minimum standards for regulation of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance. As a result of this law, hospitals, doctors and insurance companies are now required to share patient medical records and personal information on a wider basis.

Hold Harmless Clause or Hold Harmless Provision — a contract clause which forbids providers from seeking compensation from patients if the health plan fails to compensate the providers because of insolvency or for any other reason.

Home Health Agency (HHA) — an organization providing skilled nursing and other therapeutic services in the patient's home.

Home Health Care — a full range of medical and other health related services such as physical therapy, nursing, counseling, and social services that are delivered in the home of a patient, by a provider.

Home Health Services — items and services provided as needed in patients' homes by a home health agency or by others under arrangement made by an HHA. Can range from skilled nursing care and physical therapy to personal care and help with household chores.

Homemaker Service — agency providing services of trained homemakers for persons needing assistance in the home during illness or in situations where the parent or guardian is absent from the home.

Hospice — health care facility or service providing medical care and support services such as counseling to terminally ill persons and their families.

Hospice Care — care that is a part of a hospice care program given to covered persons who are terminally ill.

Hospice Care Agency — an agency or organization that has hospice care available 24 hours each day. Certified by Medicare as a hospice care agency and if required is licensed as such by the jurisdiction in which it is located.

Hospital — any institution duly licensed, certified, and operated as a hospital. The term that does not include a convalescent facility, nursing home, or any institution or part thereof which is used principally as a convalescence facility, rest facility, nursing facility or facility for the aged.