- Large Claim Pooling
System that isolated claims above a certain level and charges them to a pool funded by charges of all groups who share the pool. Designed to help stabilize significant premium fluctuations.
- Large Urban Area
An urban statistical region with population of one million or more.
- Legacy Systems
Computer applications, both hardware and software, which have been inherited through previous acquisition and installation. Most often, these systems run business applications which are not integrated with each other. Newer systems which stress open design and distributed processing capacity are gradually replacing such systems.
- Legend Drug
Drug that the law says can only be obtained by prescription.
- Limiting Charge
The maximum amount that a non-participating physician is permitted to charge a Medicare beneficiary for a particularly defined procedure or bundled service. These limits are published by the individual state intermediaries for Medicare and HCFA and are usually combined in reports with the allowed charges and regional payment schedules. In 1993, the limiting charge was set at 115 percent of the Medicare-allowed charge. However, this does not reflect what the physician will be paid.
- Local Access Transport Area (LATA)
A defined region in which a telephone and long distance carrier operates. Important concept for those CHINs that depend upon phone lines. When creating communications networks, you try to avoid crossing boundaries of these, if possible, since costs escalate dramatically when there is a need to communicate over more than one LATA.
- Local Exchange Carrier (LEC)
The telephone company that provides and supports the local connection to the public switched telephone network. In many areas of the US, the LEC is one of the seven Regional Bell Operating Companies (RBOCs) or “Baby Bells.” These LECs become partners for organizations seeking to develop a CHIN or, more conservatively, simply seeking to integrate their information system across many sites within a region.
A contractual provision by which members are required to use certain health care providers in order to receive coverage (except in cases of urgent or emergent need).
- Long Term Care
A set of health care, personal care and social services required by persons who have lost, or never acquired, some degree of functional capacity (e.g., the chronically ill, aged, disabled, or retarded) in an institution or at home, on a long-term basis. The term is often used more narrowly to refer only to long-term institutional care such as that provided in nursing homes, homes for the retarded and mental hospitals. Ambulatory services such home health care, which can also be provided on a long-term basis, are seen as alternatives to long-term institutional care.
- Long Term Care Insurance
Insurance designed to pay for some or all of the costs of long term care.
- Loss Ratio
Incurred claims plus expenses, divided by paid premiums. See also Incurred Claims Loss Ratio.