Exposure

a Group's exposure measures how heavily a group is covered. A group is a collection of members. It is also a measure of the "volume" of the coverage. For example, a group with more members is said to have more exposure than a group with less number of members. A group that have members for a longer period of time than a group with only a month or two is said to have more exposure. Such a measure of "volume' or "weight" is quantified using a term called "Exposure".

Because "Exposure" is quantified, it has to have units. The units of Exposure are the "contract months". If a groups exposure is 200 contract months, that means there are perphaps 20 members (active contracts) covered for 10 months. The word "contract" stand for a working employee that is covered under a medical contract. This number does not include the dependents of that employee.

Another dimension to the exposure is that it is measured on a per tier basis. The dependents of a covered employee based on their coverage is organized into tiers. For example the tiers could be: Employee only, Employee and Spouse, Employee and 1 child, Employee and all children. The contract months are measured for each of these configuration resulting in exposure for each tier during that contract period (usually 1 year).

TPA

This is an acronym for Third Party Administrator

FSA

Flexible spending account. The process by which tax exempted money from participant is used for his health care expenses

if you have more than one insurance, how much does the other insurance liable for the claims submitted.

if you have more than one insurance how do you coordinate the paying for claims for the benefits that are sold

GL: General Ledger

Insurance you have through a company or a group as opposed your own insurance such as medicare, medicaid or a health insurance you bought for yourself and your family (individual)

Practice of paying physicians per member per year or per month irrespective of if they see patients or not