F
F
Facility: The physical setting where healthcare services are delivered such as a medical clinic, hospital, ambulatory care setting, or emergency room.
Factored Rating: See Community Rating by Class.
Federal Qualification: The HCFA makes this designation upon its evaluation of an HMO's business process, which includes document processing, contracts, facility maintenance, etc. Organizations required federal certification to be eligible to participate in Medicare cost and risk contracts. However, this is not mandatory owing to recent legislation.
Fee-For-Service Equivalency: Refers to the difference between the amount a medical service provider (i.e. doctor) receives from an alternate reimbursement measure like capitation.
Fee Maximum: Refers to the maximum amount that a healthcare provider participating in a plan may be compensated for regarding the services extended to a covered person.
Fee Schedule: Refers to a list of codes and services that have pre-established flat rates or maximum payable amounts.
Fiduciary: Under ERISA, a fiduciary is a person who exercises control over plan assets or the plan itself.
Field Underwriting: Refers to the process that insurance sales staff use to screen prospective clients to ensure profitable sales. In some cases, field underwriting may refer to the authority for quoting premium rates or the rates of products for well-defined groups.
Financial Accounting Standard 106: Refers to a requirement that employers use to chart the expected future costs of retiree health insurance coverage.
Fixed Costs: These are costs that are payable on a monthly basis and to not relate to charges for claims or claims paid.
Flexible Benefit Plan: A benefit program offered favored by some employers. This program annually offers workers various benefit offers so that employees can tailor their benefit package to their or their family's specific needs.
Flexible Spending Account: Employees may pay into a flexible spending account for eligible dependent care or healthcare needs that are not insured. They submit with pre-tax dollars through their pre-tax payroll deduction.
Formulary - see drug formulary
Frequency: Refers to the number of times a specific service was provided.
Fully Insured: Subject to state and federal regulations, a fully insured account assumes financial risk for the payment of monthly employee premiums. The carrier, on the other hand, assumes full risk for incurred medical expenses.
Funding Level: Refers to the amount of revenue needed to finance a healthcare program. Typically, this refers to the premium rate for a fully insured program. In a self-funded program, this revenue is assessed for proposed claim costs and other related fees.
Funding Method: Refers to an employer's option for a health insurance plan. Employers may choose from various options to fund an employee health plan. Common methods include shared-risk arrangements, prospective insurance premium payments, and refunding initiatives.