Health Insurance Terms D

DBL
See Disability Benefits Law. (H)

Date of Service
The date that the health service was provided. (H)

Death Spiral
The potentially destructive cycle that may occur in an indemnity plan as a result of increased HMO penetration. The process can occur if indemnity plan rates continuously escalate because healthier and younger employees choose HMOs, leaving less healthy individuals in experience-rated indemnity plans. Employer contribution strategies and HMO pricing techniques may aggravate the problem. (H)

Deductible Carryover Credit
During the last three months of a calendar year, charges incurred for health services can be used to satisfy the deductible for the following calendar year. These credits may be applied whether or not the prior calendar year's deductible had been met. (H)

Deferred Compensation Administrator
This refers to a company that provides services under a deferred compensation plan. Services may include administration of self-insured plans, compensation planning, salary surveys, retirement planning, etc. (H)

Delete
This refers to the process of taking an individual off Medicare coverage. (H)

Dental Insurance
A group Health Insurance contract that provides payment for certain enumerated dental services. (H)

Department of Health and Human Services
A federal department whose responsibility is primarily dealing with social service functions such as administration and supervision of the Medicare program.

Dependent Coverage
Insurance coverage on the head of a family which is extended to his or her dependents, including only the lawful spouse and unmarried children who are not yet employed on a full-time basis. "Children" may be step, foster, and adopted, as well as natural. Certain age restrictions on children usually apply.

Designated Mental Health Provider
The organization hired by a health plan to provide mental health and substance abuse services.

Detoxification
The process an individual goes through when withdrawing from alcohol. Usually is done under guidance of medical personnel.

Diagnosis
The process of identifying a disease.

Diagnosis Related Groups (DRGs)
A method of classifying inpatient hospital services. It is used as a method of determining financing to reimburse various providers for services performed.

Disability Benefits Law
A state law requiring an employer to provide disability benefits to covered employees for nonoccupational injuries, in contrast to Workers Compensation, which pays for occupational injuries. These laws are currently in effect in New York, New Jersey, Rhode Island, California, and Hawaii.

Disability Buy-Sell
A disability income policy used to fund a disability buy-sell agreement whereby the business interest of a disabled stockholder following the elimination period. The policy's benefits may be paid in a lump sum or in installments.

Disability Income Insurance
A form of health insurance that provides periodic payments to replace income, actually or presumptively lost, when the insured is unable to work as a result of sickness or injury.

Disability Insurance Training Council, Inc
The educational arm of the International Association of Health Underwriters, the Health Insurance agents' professional society. It seeks to encourage agent educational projects by local Health associations, conducts university seminars in advanced Health underwriting areas, and conducts annual seminars for home office executives in sociological social insurance and demographic trends that may affect future application of policy forms and Health Insurance.

Disability, Long-Term
See Long-Term Disability.

Disability, Permanent Partial
See Permanent Partial Disability.

Disability, Permanent Total
See Permanent Total Disability.

Disability, Short-Term
See Short-Term Disability.

Disability, Temporary Partial
See Temporary Partial Disability.

Disability, Temporary Total
See Temporary Total Disability.

Discharge Planning
Determining what the patient's medical needs will be after discharge from a hospital or other inpatient treatment.

Dismemberment
The loss of, or loss of use of, specified members of the body resulting from accidental bodily injury.

Dismemberment Benefit
The benefits payable for various types of dismemberment. See also Accidental Death and Dismemberment and Multiple Indemnity.

Dread (or Specified) Disease Policy
Coverage, usually with a high maximum limit, for all types of medical expenses arising out of diseases named in the contract. Common diseases covered are poliomyelitis, diphtheria, multiple sclerosis, spinal meningitis, and tetanus. Cancer is sometimes covered or may be added with some companies by a rider.

Drug Formulary
A schedule of prescription drugs approved for use which will be covered by the plan and dispensed through participating pharmacies.

Drug Price Review (DPR)
A procedure used to determine drug price maximums. It involves determining wholesale drug prices based on the American Druggist Blue Book.

Drug Utilization Review (DUR)
A method for evaluating or reviewing the use of drugs in order to determine the appropriateness of the drug therapy.

Dual Choice
The federal requirement that employers having 25 or more employees who are within the service area of a federally qualified HMO, who are paying at least minimum wage and offer a health plan to their employees, must offer HMO coverage as well as an indemnity plan.

Duplicate Coverage Inquiry (DCI)
A request to determine whether or not other coverage exists. Used to apply the coordination of benefits provisions where two or more insurance companies are involved.

Duplication of Benefits
A situation where identical or overlapping coverage exists between two or more insurance companies or service organizations.