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RHU
Registered Health Underwriter.

Railroad Retirement
System which provides retirement and other benefits, including eligibility for Medicare, for railroad workers.

Railroad Travel Policy
Form of Accident Insurance policy sold in railroad stations by ticket agents or by vending machines. See also Travel Accident Insurance.

Rating Process
The steps used to determine a premium rate for a particular group based on the amount of risk that group presents. Items that generally go into the rating process include age, sex, type of industry, benefits, and administrative costs.

Reasonable and Customary Charges
The charge for medical services which refers to the amount approved by the Medicare Carrier for payment. Customary charges are those which are most often made by a provider for services rendered in that particular area.

Recidivism
This term refers to how often a patient returns to an inpatient hospital status for the same reason.

Recipient
Anyone designated by Medicaid as being eligible to receive Medicaid benefits.

Recurring Clause
Health Insurance policy provision defining the duration of a period of time during which the recurrence of a condition will be considered a continuation of a prior period of disability or confinement.

Referral
Occurs when a physician or other health plan provider receives permission to consult another physician or hospital.

Referral Provider
The person or provider to whom a participating provider has referred a member of the plan.

Registered Nurse (RN)
A licensed professional with a four-year nursing degree. Able to provide all levels of nursing care including the administration of medication.

Rehabilitation Clause
A clause in a Health Insurance policy, particularly a Disability Income policy, that is intended to assist the disabled policyholder in vocational rehabilitation.

Relative Value Schedule
A surgical schedule which basically compares the value of one surgical procedure to another and establishes the surgical fee to be paid.

Relative Value Unit
Sometimes used instead of dollar amounts in a surgical schedule, this number is multiplied by a conversion factor to arrive at the surgical benefit to be paid.

Residual Disability
That form of disability which becomes defined as partial disability when an insured has returned to work immediately following a period of total disability.

Residual Income
A clause used with disability income policies that provides for benefits to be paid when the insured can do some but not all of his/her normal duties. For example, if the insured suffers a disability that causes him or her to lose a third of his or her earning power, the residual disability clause would provide one-third of the benefit that the policy would provide for total disability.

Resource Based Relative Value Scale
This is a classification system which is used to determine how physicians will be compensated for services provided under Medicare benefits.

Respite Care
Normally associated with Hospice care, respite care is a benefit to family members of a patient whereby the family is provided with a break or respite from caring for the patient. The patient is confined to a nursing home for needed care for a short period of time.

Restoration of Benefits
A provision in many Major Medical Plans which restores a person's lifetime maximum benefit amount in small increments after a claim has been paid. Usually, only a small amount ($1,000 to $3,000) may be restored annually.

Retention
The portion of the premium which is used by the insurance company for administrative costs.

Retrospective Rate Derivation (RETRO)
A rating system whereby the employer becomes responsible for a portion of the group's health care costs. If health care costs are less than the portion the employer agrees to assume, the insurance company may be required to refund a portion of the premium.

Return of Premium
A rider or provision in a Health Insurance policy agreeing to pay a benefit equal to the sum of all the premiums paid, minus claims paid, if claims over a stated period of time do not exceed a fixed percentage of the premiums paid. 3

Revenue
The same as Premium.

Risk Analysis
The process of determining what benefits to offer and premium to charge a particular group.

Risk Control Insurance
See Re-insurance.

Risk Pool
See Pool.

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