Health Insurance Glossary

Learn some common terms related to Sana's self-insured plans. 

Self-Insured Plan
An employer-sponsored health plan. Most small and medium-sized companies pay for self-insured plans using level funding payment plans. Sana plans are self-insured and Employee Retirement Income Security Act (ERISA) governed.

Medical Claims
Invoices from providers for services performed. All claims are sent to Sana for processing. 

Third-Party Administrator
Also known as a TPA or plan administrator, the Third-Party Administrator provides support administering, and managing a group's benefits plan. One of the most important things that a TPA does on your behalf is receive employees’ health claims and reimburse their providers for rendered services. Sana is a TPA.

How small and mid-size employers typically pay for self-insured plans like Sana. Employers pay a fixed monthly amount for employee benefits and get reimbursed for what they don't use. 

Stop-Loss Insurance
Kicks in when excessively large claims arise. It helps Sana cover any overages, so employers are protected and never have to pay more than their expected premiums. 

Licensed professionals who provide health care services. Providers include licensed doctors of medicine or osteopathy, podiatrists, dentists, clinical psychologists, chiropractors, and more.

Medical expenses not covered by Sana. This can be certain providers, types of treatments and surgeries, and medications. Exclusions vary by plan. 

The process of assessing the risk when providing health insurance coverage and quotes to a group. This process determines whether or not we can offer coverage and sets the price based on the projected claims.

Affordable Care Act
Also known as the ACA or Obamacare. The ACA is the health care reform act aimed at expanding health insurance coverage to more Americans. The ACA requires some small businesses to offer group health care coverage to their employees.

For a more extensive glossary of common health insurance terms, please refer to HealthCare.Gov

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