Health

Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)
This act defines the primary and secondary coverage responsibilities of the Medicare program and also the provisions to be used by health plans in their contracts with the HCFA (Health Care Financing Administration).

Temporary Disability Benefits (TDB)
Legislated benefits payable to employees for nonoccupational disabilities under TDB laws in certain states. See also Disability Benefits Law.

Temporary Partial Disability
A condition where an injured party's capacity is impaired for a time, but he is able to continue working at reduced efficiency and is expected to fully recover.

Temporary Total Disability
A condition where an injured party is unable to work at all while he is recovering from injury, but he is expected to recover.

Ten Day Free Look
A notice, placed prominently on the face page of the policy, advising the insured of his or her right to examine a health policy, and if dissatisfied return the policy within ten days for a full refund of premium and no further obligation.

Tertiary Care
Services provided by such providers as thoracic surgeons, intensive care units, neurosurgeons, etc.

Terminally Ill
A term which refers to the status of a person who will normally die within 6 months of a specific illness or sickness. Often refers to the terminally ill requirement for hospice care.

Therapeutic Alternatives
Alternate drug products which may be different in chemical content, but provide the same effect when administered to patients.

Therapeutic Equivalence
Different drugs which will control a symptom or illness exactly the same as other drugs used to control that illness.

Third Party Administrator (TPA)
A firm which provides administrative services for employers and other associations having group insurance policies. The TPA in addition to being the liaison between the employer and the insurer is also involved with certifying eligibility, preparing reports required by the state and processing claims. TPA's are being used more and more with the increase in employer self-funded plans.

Third-Party Payor
This refers to any organization such as Blue Cross/ Blue Shield, Medicare, Medicaid, or commercial insurance companies which is the payor for coverages provided by a health plan.

Ticket Policy
See Transportation Ticket Policy.

Time Limit on Certain Defenses
One of the uniform individual accident and sickness provisions required by state law to be included in every Individual Health Policy. It sets a limit on the number of years after a policy has been in force that an insurer can use as a defense against a claim the fact that a physical condition of the insured existed before the policy was issued, but was not declared at that time.

Title XIX Benefits
See Medicaid.

Total Disability
A degree of disability from injury or sickness that prevents the insured from performing the duties of any occupation from remuneration or profit. The definition in any given case depends on the wording in a covering policy.

Transportation Ticket Policy
An accidental Death and Dismemberment and Disability Benefit policy issued with a common carrier ticket and limited to the risks or travel and the duration of the trip for which the ticket has been purchased. The name is derived from the fact that it was originally issued in the form of an extra stub on a travel ticket.

Travel Accident Insurance
A form of Health Insurance limiting coverage to accidents occurring while the insured is traveling.

Treatment Facility
Any facility, either residential or nonresidential, which is authorized to provide treatment for mental illness or substance abuse.

Trend Factor
The factor applied to rates which allows for such changes as increased cost of medical providers, the cost of new and expensive medical technology, etc.

Triage
A method of ranking sick or injured people according to the severity of their sickness or injury in order to ensure that medical and nursing staff facilities are used most efficiently.

Triple Option
A plan where employees have their choice, among different types of provides such as HMO, PPO, or basic indemnity plan. Usually, their choice depends on how much they want to pay for the coverage.