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Impairment: Refers to the loss or dysfunction of a physiological, anatomical, or psychological function.
In-Area Services: Healthcare that an individual receives in an authorized service area and from a network provider that is contracted with the individual's insurance plan. This is also referred to as in-network services.
Incontestability: A policy provision that asserts that an insurer may not contest a claim's validity once the policy has been active for a specified period, which is typically two to three years.
Incurred But Not Reported (IBNR): Refers to the costs of provided medical services that have not yet been filed as a claim to the insurer.
Incurred Claims: Refers to the insurer's liability over a set period of time. It includes all claims along with service dates.
Incurred Claims Loss Ratio: Refers to the billed-for claims divided by the premium payments. Typically, it is associated with a defined period of time.
Indemnity: Insurance plan for reimbursement of enrollees, doctors, hospitals, and other medical facilities and is based on billed charges. These plans typically feature deductibles, out-of-pocket limits, and co-insurance.
Independent Medical Evaluation (IME): The examination that's performed by an objective board-certified (typically) healthcare provider to determine the extent of an injury or illness.
Independent Review Organization: Refers to the independent organization or individual that reviews coverage denials based on enrollee appeals. These entities may be retained by federal or state agencies or a private insurance plan.
Individual Practice Association (IPA) Model HMO: A model of healthcare that includes contracted physicians who provide healthcare service for contracted members at a negotiated rate. Physicians are compensated on a fee schedule or a fee-for-service basis.
Initial Eligibility Period: Refers to the limited time period when an eligible individual can enroll themselves or their dependents in a health insurance plan without offering any evidence of optimum health.
Injury: Refers to bodily damage that is not caused by illness.
Inpatient: Someone admitted for care in a hospital and registered as a bed patient for 24 hours or more.
Insurability: A person is said to be "insurable" if they are in acceptable health and an insurer is willing to provide them with health coverage.
Insured Plan: Refers to when an employer contracts with an organization to provide financial responsibility for covered members' medical claims.
Integrated Behavioral Health: Refers to the carve-out coverage plan that combines managed care with behavioral health delivery. This type of plan could include such things as utilization management, employee assistance, phone counseling, and data management.
Integrated Delivery System: Refers to the combined doctor and hospital model of integration.
Integrated Provider Organization (IPO): Refers to the corporate entity that manages a diverse range of healthcare delivery. This system may feature multiple hospitals, a large group practice, or various health operations. Also see integrated delivery system.
Intermediate Care Facility (ICF): A type of facility that provides a level of care that is less than what could be expected at a hospital but greater than other care centers.
Internal Limits: Refers to the internal limit that is applied to categories of care.
Internal Revenue Service (IRS): Refer to a U.S. Treasury Department division that handles the evaluation and collection of most federal taxes. It does not collect taxes that relate to alcohol, firearms, explosives, or tobacco.
International Classification of Diseases, 9th Edition (Clinical Modification) (ICD-9-CM): This volume lists the diagnoses and their identifying codes that clinicians use to report health diagnoses.