GLOSSARY OF HEALTH INSURANCE TERMS

T

Terminal illness — life expectancy of six months or less.

Termination Date — the date that a group contract expires or an individual is no longer eligible for benefits.

Tertiary Care — specialized health care, needed by relatively few people, such as select rehabilitation services, highly technical medical procedures such as burn centers.

Tiers — to have lower costs, many prescription drug plans place drugs into different "tiers," which cost different amounts. Each plan can form their tiers in different ways. Here is an example of how a plan might form its tiers: Tier 1 - Generic drugs; Tier 2 - Preferred brand-name drugs; Tier 3 - Non-preferred brand-name drugs.

Third-party Administrator (TPA) — a firm that provides administrative functions (e.g. claims processing, membership, etc.) for a self-insured health plan.

Third-Party Payment — payment by a financial agent such as an HMO, insurance company or government rather than direct payment by the patient for medical care services. The payment for health care when the beneficiary is not making payment, in whole or in part, on his own behalf.

TRICARE — a health care program for active duty and retired uniformed services members and their families.

Two-Tier Copayment Structure — a pharmacy benefit copayment system under which a member is required to pay one copayment amount for a generic drug and a higher copayment amount for a brand-name drug.