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Table Rates: See age/gender rates
Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA): Refers to the federal legislation that developed risk and cost provisions associated with health insurance plans contracted with HCFA. It also defines the terms primary and secondary coverage associated with Medicare.
Termination Date: Refers to the date that a contract expires.
Tertiary Care: Refers to healthcare services delivered by healthcare specialists like thoracic surgeons, neurosurgeons, or medical practitioners in intensive care departments. Frequently, these medical services require advanced technology and medical facilities.
Therapeutic Alternatives: Refers to drugs that provide similar effects to other pharmacological treatments but have different chemical entities.
Therapeutic Substitution: Refers to the dispensing of a therapeutically equivalent drug for another, typically one that is less expensive but provides a similar effect. See also Generic Substitution.
Third-Party Administrator (TPA): A third-party entity or independent individual who administers health benefits for a group and handles claims administration. This entity does not underwrite financial risk.
Third-Party Payer: Refers to a private or public entity that pays / underwrites health coverage for medical expenses for another group or entity. An employer can be referred to as a third-party payer.
Tort Reform: This reform eliminates unnecessary testing or other practices that were historically performed by physicians but resulted in too little or no value for the patient.
Traditional Fee-for-Service Plan: Refers to a plan which finances medical care but does not provide healthcare services. Participants of this type of plan may consult any healthcare provider. In this model, employers pay premiums to an insurer who then provides enrollees with a benefits package.
Treatment Facility: Refers to an inpatient or outpatient licensed medical facility where individuals can obtain medical treatment.
Trend Factor: Percentage of increase that an insurer uses to plan or interpret the projected increase in medical costs. Insurers will consult factors like utilization, inflation, and geographic information when performing their interpretations.
Trending: Refers to the calculation employed to predict a group's estimated utilization based on prior usage.
Triage: Refers to the categorization of insured or sick individual in accordance with severity levels and used by emergency room staff or nursing care facilities to guide them in the treatment of patients seeking care.
Triple Option: A health insurance plan that allows employees to choose one of three insurance plans. A typical choice of plans may include PPO, HMO, and indemnity plan. Employees make their selection based on their needs and the financial obligations associated with each.
Trust Fund: The entity that controls, invests, and administers moneys or securities on behalf of others.
Turnaround Time (TAT): Refers to the measurement of a process and is often associated with claims processing. This measurement may include the amount of days from the date claim when that claim is actually paid.