Health Insurance Glossary C

Cancellation clause

A clause in an insurance contract which permits an insurer and/or an insured to cancel the contract before it is due to expire. The clause may provide for a return of premium in respect of the unused portion of the policy.

Care Plan

A written plan for one's health care

Case Management

A process whereby an insured person with specific health care needs is identified and a plan which efficiently utilizes health care resources is designed and implemented to achieve the optimum patient outcome in the most cost-effective manner.

Case Manager

A nurse, doctor, or social worker who arranges all services that are needed to give proper health care to a patient or group of patients.

Catastrophic Illness

A very serious and costly health problem that could be life threatening or cause life-long disability. The cost of medical services alone for this type of serious condition could cause financial hardship.

Centers of Excellence

Hospitals that specialise in treating particular illnesses, or performing particular treatments, such as cancer or organ transplants.

Certificate of Coverage

A document given to an insured that describes the benefits, limitations and exclusions of coverage provided by an insurance company.

Claim

Form submitted to a payer (by a health care provider or patient) to request payment for items or services.

Claims made policy

A policy which only pays claims that are notified to the insurer during a specified period.

Clinical Practice Guidelines

Reports written by experts who have carefully studied whether a treatment works and which patients are most likely to be helped by it

Co-insurance

Cost-sharing arrangement between an insured person and the health insurance company in which the insured person is required to pay a percentage of the cost for the health care services received. Coinsurance typically applies after satisfaction of a deductible.

Concurrent Review

Concurrent review involves monitoring the medical treatment and progress toward recovery, once a patient is admitted to a hospital, to assure timely delivery of services and to confirm the necessity of continued inpatient care. This monitoring is under the direction of medical professionals. Concurrent review is a component of "Utilization Review."

Contract Year

The period of time from the effective date of the contract to the expiration date of the contract. A contract year is typically 12 months long, but not necessarily from January 1 through December 31.

Coordinated Care

Links the treatments or services necessary to obtain an optimum level of medical care required by a patient and provided by appropriate providers. It is also another term for "managed care" used by federal government officials.

Cost Sharing

This occurs when the users of a health care plan share in the cost of medical care. Deductibles, coinsurance, and co-payments are examples of cost sharing.

Covered Benefit

A health service or item that is included in a health plan, and that is partially or fully paid by the health plan.

Covered Charges/Expenses

Most insurance plans, whether they are PPOs or HMOs, do not pay for all services. Some may not pay for prescription drugs. Others may not pay for mental health care. Covered services are those medical procedures for which the insurer agrees to pay. They are listed in the policy.

Covered Person

An individual who meets eligibility requirements and for whom premium payments are paid for specified benefits of the contractual agreement.

Creditable Coverage

Any previous health insurance coverage that can be used to shorten the pre-existing condition waiting period. See "HIPPA".

Critical Access Hospital

A small facility that gives limited outpatient and inpatient hospital services to people in rural areas.

Custodial Care

Personal care, such as bathing, cooking, and shopping.

Caesarean section

A caesarean section, commonly known as a c-section, is a surgical procedure to deliver a baby through an incision made in the abdomen. In the UK, approximately one in three babies is born via this method. When complications arise during pregnancy, a caesarean section may be the safest option for delivery. However, it's crucial to recognise that it is a major surgical procedure with associated risks. It's important for individuals advised to undergo or considering a caesarean to be fully informed about these risks.

Calcium-channel blockers

Calcium-channel blockers are medications that target the cells of the heart and blood vessels, regulating their function. They are utilised in the treatment of various health conditions, impacting factors such as blood pressure and heart rhythm.

Cardioversion

Cardioversion is a medical procedure aimed at restoring normal heart rhythm in cases where the heartbeat is irregular, excessively fast, or slow. It is used to treat abnormal heart rhythms (arrhythmias) and conditions such as atrial fibrillation, characterised by irregular and excessively rapid heartbeats. One type of cardioversion is electrical or direct-current (DC) cardioversion, which involves the use of an electric shock to reset the heart's rhythm.

Carpal tunnel release surgery

Carpal tunnel release surgery is a procedure aimed at alleviating the symptoms associated with carpal tunnel syndrome (CTS), which may include numbness, weakness, tingling, and pain in the hand. During the operation, a ligament in the wrist is divided to relieve pressure on the nerve responsible for controlling thumb movement and sensation in the hand.

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) occurs when a nerve in the wrist becomes compressed or squeezed, typically due to pressure on the nerve. This condition can result in symptoms such as tingling, numbness, pain, and weakness in the hand. While carpal tunnel syndrome may improve spontaneously, there are also treatment options available to alleviate symptoms and promote recovery.

Cataract surgery

Cataract surgery involves the removal of a cloudy lens (cataract) from the eye and its replacement with an artificial lens, ultimately enhancing vision clarity. This procedure is highly successful for most individuals and often leads to a significant improvement in quality of life by restoring clearer vision.

Cataract

A cataract occurs when the lens of the eye becomes cloudy, diminishing its transparency. This cloudiness can gradually lead to blurred or misty vision over time. Cataracts typically develop slowly over several years.

Cervical artery dissection

Cervical artery dissection is characterised by a tear in the wall of one of the major blood vessels (arteries) in the neck, leading to the formation of blood clots within the arteries. This condition can disrupt the blood supply to the brain, making it one of the primary causes of stroke in individuals under the age of 50.

Cervical cancer

Cervical cancer occurs when the cells of the cervix, the neck of the womb, undergo abnormal growth and proliferation. The primary cause of cervical cancer is human papillomavirus (HPV), a virus that infects the cells of the cervix and can lead to cancerous changes over time.

Cervical screening (Smear test)

Cervical screening, also known as a smear test or Pap test, examines the health of the cervix, the neck of the womb. During the test, a sample of cells is collected and tested for the presence of the human papillomavirus (HPV), a virus associated with cervical cancer. If HPV is detected, the sample is further analyzed for any abnormal changes in the cells, which could potentially progress to cervical cancer if left untreated.

Chemotherapy

Chemotherapy, often referred to as chemo, involves the use of medications to eliminate cancer cells from the body. It is a treatment option recommended by doctors for individuals diagnosed with cancer, either as a standalone treatment or in conjunction with other therapeutic approaches.

Chickenpox

Chickenpox is a highly contagious disease caused by the varicella-zoster virus. It spreads easily, typically through direct contact or airborne droplets, and is most prevalent among children. Symptoms include an itchy rash with small blisters and general feelings of malaise.

Chiropractic for lower back pain

Chiropractic is a healthcare profession centered around diagnosing and treating disorders affecting the bones, muscles, and joints, particularly conditions like lower back pain. Chiropractors, healthcare practitioners specialising in this field, primarily utilise manual techniques, such as spinal manipulation, to address these issues. Additionally, they may employ other therapeutic modalities to complement treatment.

Coeliac disease

Coeliac disease is a condition in which the body reacts adversely to gluten, a protein present in certain foods like bread, cereals, and pasta. This immune response damages the lining of the small bowel, leading to various symptoms such as diarrhea, abdominal cramps, and bloating. This condition can develop at any age, and the primary treatment involves adhering to a lifelong gluten-free diet. For most individuals with coeliac disease, following this diet effectively alleviates symptoms and improves overall health.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a form of psychotherapy designed to enhance mental health by addressing and modifying negative thoughts and beliefs that impact emotions and behaviours. Through CBT, individuals acquire valuable skills that can be beneficial for a lifetime, empowering them to manage challenges effectively and improve overall well-being.

Colonoscopy

A colonoscopy is a medical procedure involving the use of a thin, flexible, tube-like instrument called a colonoscope to examine the interior of the large bowel, also known as the colon or large intestine. This procedure is employed to investigate symptoms affecting the bowel and to screen for signs of bowel cancer.

Colposcopy

A colposcopy is a straightforward examination used to closely inspect the cervix, which is the neck of the womb, and the vagina. It is employed to identify abnormal cells that have the potential to develop into cancer. If such cells are detected, they can be removed or treated during the procedure.

Conjunctivitis

Conjunctivitis is a condition that impacts the eyes, often resulting in redness, a gritty sensation, and increased tear production or stickiness. Commonly known as pink eye, conjunctivitis can occur in individuals of all age groups.

Coronary angioplasty

Coronary angioplasty is a medical procedure aimed at widening narrowed or blocked arteries in the heart. By doing so, blood flow is improved, allowing the heart muscle to receive the necessary oxygen. This procedure is utilised to alleviate symptoms of angina and can also serve as an emergency intervention for individuals experiencing a heart attack.

Coronary heart disease

Coronary heart disease refers to the accumulation of fatty deposits within the arteries responsible for supplying blood to the heart. This buildup can narrow the arteries, leading to reduced oxygen delivery to the heart. Consequently, individuals may experience symptoms such as chest pain and difficulty breathing. Moreover, coronary heart disease heightens the risk of future heart attacks.

Corticosteroids

Corticosteroids are medications that play a role in regulating various bodily functions, including inflammation reduction and immune system modulation. Available in numerous forms, corticosteroids are utilised in the treatment of a wide range of medical conditions. They are commonly referred to simply as "steroids."

Crohn’s disease

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any segment of the digestive tract, leading to symptoms such as abdominal pain, persistent diarrhoea, and ulcer formation. It is one of the primary types of IBD, with ulcerative colitis being the other major form.

CT Scan

A computerised tomography (CT) scan is a diagnostic imaging technique used to generate detailed images of the interior of the body. This method involves taking X-ray images from different angles, which are then processed by a computer to produce cross-sectional images of the body's structures. CT scans are valuable in diagnosing and monitoring a wide range of health conditions.

Cystitis

Cystitis is a prevalent form of urinary tract infection (UTI) that affects the bladder, typically stemming from bacterial infection. In many cases, cystitis resolves spontaneously within a few days. However, treatment may be necessary at times to eliminate the infection and prevent potential complications.