Health Insurance Glossary

Date of Service
The date that the service was rendered.
Day Treatment Center
An outpatient psychiatric facility or hospital which is licensed to provide outpatient care and treatment of mental or nervous disorders or substance abuse under the supervision of physicians.
The dollar amount of covered services based on the allowed benefit that must be paid by an individual or family per benefit period before the insurance company (CareFirst) begins to pay its portion of claims.
Dental Care
Routine preventive and treatment of teeth and the structures directly supporting the teeth. Generally, dental care is not covered by the health benefit plan.
A member who is covered as the spouse, eligible child or grandchild of a subscriber (the employee).
Detailed Explanation of Summary
A breakdown of charges to show how benefits were applied.
Diagnostic Tests
Medically necessary test(s) and/ or non-surgical procedure(s) ordered by a physician/ dentist to determine if the patient has a certain condition or disease. Such diagnostic tools include radiology, laboratory, pathology services or tests.
Disease Management
Programs for members with chronic health conditions. Services range from quarterly mailings to case management with 24-hour access by phone to a support nurse.
Drug Formulary
See Formulary.
Duplicate Coverage
Enrollment of one person for the same type of benefits under more than one contract. See Coordination of Benefits (COB).
Durable Medical Equipment (DME)
Goods, implements, prosthetics, etc., that are prescribed for patient care, usually in an outpatient setting. Examples of such equipment include hospital beds, wheelchairs and walkers.