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Accident-Only Policies: Policies that pay only in cases arising
from an accident or injury.
Acute Care: Medical care for an episode of injury or an illness.
Agent/Producer: A person who represents your health plan company
and solicits or sells the companys health plans. An agent/producer may represent
a single company or multiple companies.
Alabama Breast and Cervical Cancer Treatment Program: Program that
provides free screening for breast and cervical cancer to eligible Alabama residents.
Women diagnosed with breast or cervical cancer may be eligible for free coverage
through Medicaid for treatment of their condition.
Affiliation Period: The time an HMO (Health Maintenance Organization)
may require you to wait after you enroll and before your coverage begins. HMOs that
require an affiliation period cannot exclude coverage of pre-existing conditions.
Premiums cannot be charged during HMO affiliation periods. See also HMO.
Alabama Health Insurance Plan: A state-run health insurance program
for people who are eligible under HIPAA (Health Insurance Portability and Accountability
ALL Kids (Also Known as CHIP): A state-run health insurance program
for children under the age of 19 whose families meet financial eligibility criteria.
ALL Kids provides comprehensive benefits and has no pre-existing condition exclusions.
Depending on your financial situation, ALL Kids may be free or may have very modest
Allied Health Care Providers: Specially trained health care professionals
other than physicians. Allied health care providers include optometrists, chiropractors,
podiatrists, and nurse practitioners.
Allowable Charges: The specific dollar amount of a medical bill
that Medicare, Medicaid, or your health plan will pay.
Alternative Trade Adjustment Assistance (ATAA) Program: A benefit
for workers at least 50 years old who have obtained different, full-time employment
within 26 weeks of the termination of adversely affected employment. These workers
may receive 50% of the wage differential (up to $10,000) during their 2 year eligibility
period. To be eligible for ATAA benefits, workers cannot earn more than $50,000
per year in their new employment. Also, the firm where the workers worked must meet
certain eligibility criteria.
Ambulatory Care: Medical care for an injury or an illness that
can be provided on an outpatient basis.
Ancillary Services: Special services ordered by your physician,
such as laboratory, radiology, durable medical equipment, and pharmacy services.
Capitation: A payment method in which the provider
agrees to provide all the care you may need in return for a fixed monthly payment
by your health plan company.
Case Management: Coordination of your health care services and
providers when you have a serious accident or injury or chronic illness. Case management
allows your health plan to coordinate your treatment.
Certificate of Coverage: A document you receive from your health
plan that explains what health care services your plan will pay for, what services
you may have to pay for, and what rules you must follow to receive services.
Certificate of Creditable Coverage. A document provided by your
health plan that lets you prove you had coverage under that plan. These certificates
will usually be provided automatically to you when you leave a health plan. You
can obtain certificates at other times as well. See also Creditable Coverage.
Chronic Illness: An illness that lasts a long time or an illness
that will never be cured, such as diabetes and arthritis.
Claim: A request that you or your health care provider makes to
the health plan to pay for a health care service provided to you. Most health plans
require claims to be in writing. Health plans require claims to be on a specific
Closed Practice: A primary care physician who is not accepting
new patients. Note: Even if your physician is on the HMO (Health Maintenance Organization)
or PPO (Preferred Provider Organization) list, call to see if the practice is still
open for accepting new HMO or PPO participants.
Co-insurance: The amount you are required
to pay for health care services in a health plan after you have met your deductible.
The coinsurance rate is usually expressed as a percentage. For example, if your
health plan pays 80% of the claim, then you pay 20%.
Community Health Center: A clinic designated by the United States
Public Health Service to provide health services in a neighborhood because of needs
in that neighborhood. (Also known as a Federally Qualified Health Center.)
Consolidated Omnibus Budget Reconciliation Act (COBRA):
A federal law in effect since 1986. COBRA permits you and your dependents to continue
in your employers group health plan after your job ends. If your employer
has 20 or more employees, you may be eligible for COBRA continuation coverage when
you retire, quit, are fired, or work reduced hours. Continuation coverage also extends
to surviving, divorced, or separated spouses; dependent children; and children who
lose their dependent status under the rules of their parents plan. You may
choose to continue in the group health plan for a limited time and pay the full
premium, including the share your employer used to pay on your behalf. COBRA continuation
coverage generally lasts 18 months, or 36 months for dependents in certain circumstances.
Consumer Choice Plans: Health care plans offered by carriers that
do not include all of the state-mandated benefits. Consumer choice plans must provide
members with a disclosure statement and a list describing the state-mandated benefits
that are not covered.
Continuous Coverage: Under federal rules, health insurance coverage
that is not interrupted by a break of 63 or more consecutive days. Employer waiting
periods and HMO (Health Maintenance Organization) affiliation periods do not count
as gaps in health insurance coverage for the purpose of determining whether coverage
is continuous. See also Creditable Coverage and HIPAA Eligible.
Coordination of Benefits (COB): Rules and procedures that determine
how health care claims are paid when you are covered by more than one health insurance
plan. Together, the health plans cannot pay more than the charge for the services.
Co-payment: A fixed amount (for example, $15)
you pay for a covered health care service, usually when you receive the service.
The amount can vary by the type of covered health care service.
Covered Expenses: Most insurance plans, whether they are fee for
service, HMOs (Health Maintenance Organizations), or PPOs (Preferred Provider Organizations),
do not pay for all services. Some may not pay for prescription drugs. Others may
not pay for mental health care. Covered services are those medical procedures the
insurer agrees to pay for. They are listed in the policy.
Deductible: The amount you owe for health
care services your health plan covers before your health plan begins to pay. For
example, if your deductible is $1,000, your plan wont pay anything until youve
met your $1,000 deductible for covered health care services subject to the deductible.
The deductible may not apply to all services. Beginning in 2014, deductibles for
small group health plans will be limited to $2,000 for individual policies and $4,000
for family policies. Not all plans require deductibles.
Disability Benefits: Insurance company coverage that pays for lost
wages when you are unable to work because of an illness or injury.
Disease Managment:Refers to the process of improving or maintaining
health. It is concerned with common chronic diseases, and the reduction of future
complications associated with those diseases.
Dread Disease Policies: Policies that pay only if you contract
the illness specified in the policy. Also called specified disease policies.
Effective Date: The date on which coverage under
an insurance policy begins.
Emergency Care: Health care services provided in a hospital emergency
facility or comparable facility to evaluate and stabilize sudden and severe medical
Emergency Medical Services (EMS): Emergency care provided by ambulance
personnel, such as EMTs (emergency medical technicians), paramedics, first responders,
or other authorized individuals.
Eligible Employee: An employee who meets the eligibility requirements
for coverage in a group plan. To be eligible to join a group plan, you usually must
work full time for at least 30 hours a week. Some group plans may require employees
to be a certain pay grade or job classification to be eligible for coverage.
Elimination Rider: An amendment in individual health insurance
policy contracts that permanently excludes your coverage for a health condition,
body part, or body system.
Enrollment Period: The period during which all employees and their
dependents can sign up for coverage under an employer group health plan. Besides
permitting workers to elect health benefits when first hired, many employers and
group health insurers hold an annual enrollment period, during which all employees
can enroll in or change health coverage. See also Group Health Plan and Special
ERISA Plan: Health plans created under the Employee Retirement
and Income Security Act (ERISA) of 1974. These plans are self-funded; that is, claims
are paid strictly from employer contributions and employee premiums. ERISA plans
are administered by the U.S. Department of Labor. (Also known as a self-funded plan.)
Evidence of Insurability: Proof that you are in good health. Some
insurers require you to provide information about your medical history and health
status to determine whether they will insure you or whether they will exclude certain
Exclusions: Charges, services, or supplies that are not covered
under an insurance policy.
Family and Medical Leave Act (FMLA): A federal
law that guarantees up to 12 weeks of job-protected leave for certain employees
when they need to take time off because of a serious illness, to have or adopt a
child, or to care for another family member. When you qualify for leave under the
FMLA, you can continue coverage under your group health plan.
Family Practitioner: A physician who provides primary health care
for individuals and families.
Federally Qualified Health Center: A clinic designated by the United
States Public Health Service to provide health services in a neighborhood because
of needs in that neighborhood.
Fee for Service: A traditional method of paying
for medical services where doctors and hospitals are paid a fee for each health
care service they provide.
Flexible Spending Account (FSA): An account
funded by the employee from pre-tax income and is used to pay for medical expenses.
The entire annual amount of an FSA must be made available to the employee at the
beginning of the year. However, unspent balances must be forfeited to the employer
at the end of the year.
Formulary:A list of prescription drugs covered by a particular
health plan. You may pay varying co-payments for drugs that are on the formulary.
For drugs that are not on the formulary, you may be required to pay a larger percentage
of the cost, sometimes 100%. Most formularies cover at least one drug in each drug
class, and encourage generic substitution.
Gatekeeper: A health care provider who determines
whether you should see a specialist or receive other non-routine services. The goal
of the gatekeeper is to guide the patient to appropriate services while avoiding
Genetic Information: Includes information about family history
or genetic test results indicating your risk of developing a health condition. Health
plans cannot consider a condition identified by genetic information to be pre-existing
(and therefore excluding coverage for it) unless that health condition has been
previously diagnosed by a health professional.
Grievance Procedure: The required appeal process an HMO (Health
Maintenance Organization) provides for you to protest a decision regarding medical
necessity or claim payment. Insurance companies also may have grievance procedures.
Gross Income: The total of all income of a
person during a period, which is subject to tax after considering allowable deductions
and credits. Income can include, but is not limited to, the following: compensation
for services, including commissions, fringe benefits, etc.; gross income derived
from business; pensions; annuities; alimony; interest income from an estate or trust;
dividends; rents, interest; royalties; and gains derived from dealings in property.
Gross Salary: Earnings of a person prior to
the deduction of income tax.
Group Insurance: A health plan that is purchased for a group of
eligible people, usually by an employer for its employees. In Alabama, there are
two forms of group health plans: small group (for groups of 250 individuals) and
large group (for groups of 51 or more individuals).
Guaranteed Renewable: Policies that may not be non-renewed or canceled,
except in certain cases. An insurer may cancel a guaranteed renewable policy for
failure to pay premiums, fraud, or intentional material misrepresentation. It also
may cancel your policy if the company formally leaves the individual or group health
Health Coverage Tax Credit (HCTC): A program that
can help pay for nearly two thirds of eligible individuals health plan premiums.
In general, in order to be eligible for the tax credit, you (a) must be receiving
Trade Readjustment Allowance (TRA) benefits or (b) will receive TRA benefits once
your unemployment benefits are exhausted or (c) are receiving benefits under the
Alternative Trade Adjustment Assistance (ATAA) program or (d) are age 55 or older
and receiving benefits from the Pension Benefit Guaranty Corporation (PBGC).
Health Insurance: Financial protection
against all or part of the medical care costs to treat illness or injury. Health
insurance may also include benefits for preventive health care to help you stay
Health Insurance Portability and Accountability Act (HIPAA) of 1996:
A federal law that includes important health insurance provisions, including non-discrimination,
guaranteed renewability, guaranteed issue, and limits to benefit exclusions because
of pre-existing medical conditions.
Health Maintenance Organization (HMO): A health
plan that provides coverage through a network of hospitals, physicians and other
health care providers. HMOs typically require the selection of a primary care physician
who is responsible for managing and coordinating all health care. Usually, referrals
to specialist physicians are required, and the HMO pays only for care provided by
an in-network provider.
Health Reimbursement Arrangement (HRA): A tax-exempt
account that can be used to pay for qualified health expenses. HRAs are usually
paired with a high-deductible health plan and are funded solely by employer contributions.
Health Savings Account (HSA): A tax-exempt savings
account that can be used to pay for qualified medical expenses. Individuals can
obtain HSAs from most financial institutions, or through their employer. Both employers
and employees can contribute to the plan. To open an HSA, an individual must have
health coverage under an HSA-qualified high-deductible health plan.
Health Status: When used in this guide, refers to your medical
condition (both physical and mental illnesses), claims experience, receipt of health
care, medical history, genetic information, evidence of insurability (including
conditions arising out of acts of domestic violence), and disability. See also Genetic
High-Deductible Health Plan (HDHP): These health
plans have higher deductibles and lower premiums than traditional health plans.
In 2011 and 2012, an HSA qualifying HDHP must have a deductible of at least $1,200
for single coverage and $2,400 for family coverage. The plan must also limit the
total amount of out-of-pocket cost sharing for covered benefits each year to $5,950
for single coverage and $11,900 for family coverage and $6,050 for single coverage
and $12,100 for family coverage, for 2011 and 2012 respectively.
High-Risk Pools: In some states, these pools provide a health insurance
option for individuals whose poor health creates a barrier to obtaining employer-based
coverage. Premiums in high-risk pools are relatively high, and there is often a
waiting period before benefits are available. However, many states have non-discrimination
laws that eliminate the need for these pools.
Hospice: A facility or program that provides care for a terminally
Indemnity Plan: A limited
benefit health plan that allows you to go to any physician or provider you choose
but requires that you pay for the services.
Individual Insurance: A health insurance policy purchased by an
individual rather than a group plan purchased by an employer.
Inpatient: A person admitted to a health care facility to receive
health care services.
Large Group Health Plan: A plan with more than
Late Enrollment: Enrollment in a health plan at a time other than
the regular or a special enrollment period. If you are a late enrollee, you may
be subject to a longer pre-existing condition exclusion period. See also Special
Lifetime Maximum: The total dollar amount a health plan will pay
over your lifetime.
Long-Term Care Benefits: Coverage that provides help for people
when they are unable to care for themselves because of prolonged illness or disability.
Benefits are triggered by specific findings of "cognitive impairment" or inability
to perform certain actions known as "activities of daily living." Benefits can range
from help with daily activities while recuperating at home to skilled nursing care
provided in a nursing home.
Look Back: The maximum length of time, immediately prior to enrolling
in a health plan, that can be examined for evidence of pre-existing conditions.
Major Medical Policies: Health care policies that
usually cover both hospital stays and physicians´ services in and out of the
Managed Health Care: A system that organizes physicians, hospitals,
and other health care providers into networks with the goal of lowering costs while
still providing appropriate medical services. Many managed care systems focus on
Preventive care and case management to avoid treating more costly illnesses.
Mandated Offerings: Health care benefits that must be offered to
the employer or organization sponsoring a group policy. The sponsor is not required
to include the benefits in its group plan.
Maximum Out-of-Pocket Expense: The maximum amount someone covered
under a health care plan must pay during a certain period of time for expenses covered
by the plan. Until the maximum is reached, the person covered is required to pay
a co-payment or a percentage of each claim.
Medically Necessary Care: Health care that results from illness
or injury or is otherwise authorized by the health care plan. This term can be defined
differently from one health care plan to another.
Medicaid (Title XIX): A health care program for people who meet
certain income and other guidelines. Medicaid is paid for by federal and state funds.
Medical Underwriting: A pricing practice used by insurance companies
to adjust premiums (usually upward) based on a groups health status or medical
Medical Savings Account (MSA): A tax-deferred account established
to pay for medical expenses not covered by an insurance policy.
Medicare (Title XVIII): A federal health insurance program for
people over age 65 and for certain people with disabilities.
Medicare Supplemental Insurance: A policy that covers certain medical
expenses not fully covered by Medicare.
Multiple Employer Plans: Benefit plans that serve employees of
more than one employer and are set up under terms of a collective bargaining agreement.
Network: All physicians,
specialists, hospitals, and other providers who have agreed to provide medical care
to HMO (Health Maintenance Organization) members under terms of the contract with
the HMO. Insurance contracts with PPO (Preferred Provider Organization) benefits
also use networks.
Noncancellable Policy: A policy that guarantees you can receive
insurance, as long as you pay the premium. (Also called a guaranteed renewable policy.)
Nondiscrimination: A requirement that group health plans not discriminate
against you based on your health status. Your coverage under a group health plan
cannot be denied or restricted, and you cannot be charged a higher premium because
of your health status. Group health plans can restrict your coverage based on other
factors (e.g., part-time employment) that are unrelated to health status. See also
Group Health Plan, Health Status.
Non-Preferred Providers: A health care provider (such as a hospital
or doctor) that is not contracted with your health plan. Depending on the health
plans rules, you may not be covered at all or you may be required to pay a higher
portion of the total costs when you use a non-preferred provider. These providers
may also be known as out-of-network or non-participating providers.
Nurse Practitioner (NP): A registered nurse specially educated
and licensed to provide primary and/or specialty care.
Open Access (OA) Plan: An HMO or POS plan in which
patients are allowed to self-refer to specialists for a higher co-pay.
Out-of-Pocket Costs: care expenses paid by you because they are
not paid by your health plan.
Out-of-Area: The area outside the counties or ZIP Codes in which
an HMO (Health Maintenance Organization) provides regular and preventive coverage.
Out-of-Network Services: Health care services from non-preferred
Outpatient Services: Services usually provided in clinics, physician
or provider offices, hospital-based outpatient departments, home health services,
ambulatory surgical centers, hospices, and kidney dialysis centers.
Preferred Providers: A health care provider (such
as a doctor or hospital) that contracts with your health plan. The provider agrees
to the plans rules and fee schedules and agrees not to balance bill you for amounts
beyond the allowed fee schedule. These providers may also be known as in-network
providers or participating providers.
Pension Benefit Guaranty Corporation (PBGC): A federal government
corporation established by Title IV of the Employee Retirement Income Security Act
(ERISA) of 1974 to encourage the continuation and maintenance of defined benefit
pension plans and to provide timely and uninterrupted payment of pension benefits
to participants and beneficiaries in plans covered by PBGC. It currently guarantees
payment of basic pension benefits earned by American workers and retirees participating
in private-sector defined benefit pension plans. PBGC receives no funds from general
tax revenues. Operations are financed largely by insurance premiums paid by companies
that sponsor pension plans and by PBGCs investment returns.
Physician Assistant (PA): A specially trained individual who provides
medical care usually provided by a physician.
Point-of-Service (POS) Plans: A plan that allows
an HMO to contract with an insurance company to give enrollees the option of receiving
services outside the HMO4s network.
Pre-Certification: A requirement that the health care plan must
approve, in advance, certain medical procedures. Pre-certification means the procedure
is approved as medically necessary, not approved for payment.
Pre-Existing Condition Exclusion Period: The time during which
a health plan will not pay for covered care relating to a pre-existing condition.
See also Pre-Existing Condition.
Pre-Existing Condition: An illness or medical
condition, that existed prior to your applying for a health plan, whether or not
any medical advice or treatment was recommended or received. The ACA prohibits health
plans from imposing any pre-existing condition exclusions for plan and policy years
beginning after September 23, 2010 for children under 19, and for all others beginning
Preferred Provider Organization (PPO): A network
of medical providers that contracts with a health plan to provide services at pre-negotiated
Premium: The amount that you and/or your
employer pay for health insurance, usually paid in installments.
Preventive care: Health care that focuses
on healthy behavior and providing services that help prevent health problems. This
includes health education, immunizations, early disease detection, health evaluations,
and follow-up care.
Prior Authorization: Approval of a health care service or medication
before it is provided in order for the health plan to cover the expense.
Primary Care Provider: A physician (M.D.
Medical Doctor or D.O. Doctor of Osteopathic Medicine), nurse practitioner,
clinical nurse specialist or physician assistant, as allowed under state law, who
provides, coordinates or helps a patient access a range of health care services.
Provider: A physician (M.D. Medical Doctor or D.O. Doctor of
Osteopathic Medicine), health care professional or health care facility licensed,
certified or accredited as required by state law.
Provider Choice: The degree to which enrollees can choose which
doctor or health care provider to see varies by plan typeHMOs, PPOs, POS plans,
and OA plans. HMOs have the least provider choice. They require participants to
see professionals only within the plans relatively narrow network. PPOs tend to
have broader networks of preferred providers and allow access to non-preferred providers,
but at a higher cost.
Provider Network: All the doctors, specialists, hospitals, and
other providers who agree to provide medical care to HMO or PPO members under terms
of the health plan.
Quality Assurance: Activities to ensure and improve
the quality of medical care that is provided by reviewing the care and working to
correct any problems.
Rate-Up: The extent to which premiums are increased,
usually annually. Premium rate-ups are typically expressed as a percentage increase.
For example, a premium that increases from $1,000 per year to $1,100 per year has
a rate-up of 10%.
Referral: A direction from your doctor to
receive care from a different provider or facility.
Respite Care: Providing patient care so the primary health caregiver
can rest or take time off.
Rural Health Clinic: There are two types of rural health clinics:
Independent and Provider Based. Services include any medical service typically furnished
by a physician in an office or a home visit.
- Services provided by Independent Rural Health Clinics (IRHC) include
those provided by physicians, nurse practitioners and/or physician assistants during
the clinic's normal operation.
- Provider Based Rural Health Centers (PBRHC) are an integral part
of a hospital, skilled nursing facilities or home health agency. Services may be
provided by a physician, physician assistant, nursing practitioner, certified nurse
midwife, and/or specialized nurse practitioner.
Self-Funded Plans: Plans funded strictly from employer
contributions and employee premiums. These plans are authorized by the federal Employee
Retirement and Income Security Act (ERISA) of 1974 and are regulated by the U.S.
Department of Labor. State regulation of these plans is limited. Although an insurance
company may be hired to administer the plan, the insurance company assumes no risk.
(Also known as ERISA plans.)
Self-Paying Patients: Individuals who pay out of pocket for the
medical care they receive.
Service Area: The counties, or portions of counties, where an HMO
or PPO provides coverage.
Skilled Nursing Care: Care needed after a serious illness. Such
care is available 24 hours a day from skilled medical personnel, such as registered
nurses or professional therapists. A doctor orders skilled nursing care as part
of a treatment plan
Special Enrollment Period: A time, triggered by certain specific
events, during which you and your dependents must be permitted to sign up for coverage
under a group health plan. Employers and group health insurers must make such a
period available to employees and their dependents when their family status changes
or when their health insurance status changes. Special enrollment periods must last
at least 30 days. Enrollment in a health plan during a special enrollment period
is not considered late enrollment. See also Late Enrollment.
Specified Disease Policies: Policies that pay only if you contract
the illness specified in the policy. (Also called dread disease policies.)
Specified Medical Limitations: A dollar limit placed on treatment
of certain medical conditions or types of treatment.
Supplemental Security Income (SSI): A program providing cash benefits
to certain very low income, disabled, and elderly individuals. When you qualify
for SSI, you generally also qualify for Medicaid. In addition, Medicaid coverage
often continues for a limited time if your income increases to the point that you
no longer qualify for SSI.
State Continuation Coverage: A law in many states that is similar
to COBRA in that it covers persons who work for employers with 219 employees.
Alabama does not have a state continuation law. See also COBRA.
Temporary Assistance for Needy Families (TANF):
A program (also known as Family Assistance or FA) that provides cash benefits to
low income families with children. When you qualify for TANF, you generally also
qualify for Medicaid. In addition, Medicaid coverage often continues for a limited
time or longer if you no longer qualify for TANF. See also Medicaid.
Tertiary Care: Highly specialized medical care that may require
the use of specialized medical facilities.
Third-Party Payer: Anyone paying for the health care who is not
the patient (first party) or the caregiver (second party).
Trade Adjustment Assistance (TAA) Program: A program authorized
by the Trade Adjustment Assistance Reform Act of 2002. This program provides aid
to workers who lose their job or whose hours of work and wages are reduced as a
result of increased imports. The TAA Program offers six benefits and re-employment
services to assist unemployed workers prepare for and obtain new suitable employment.
In addition, TAA offers a significant tax credit that covers 65% of health insurance
premiums for certain plans.
Underinsured: People with inadequate health insurance
that does not cover all necessary medical care.
Underwriting: The process insurance companies use to examine, accept,
reject, and classify the risks associated with a person or group who is applying
U.S. Department of Labor: A department of the federal government
that regulates employer- provided health benefit plans. You may need to contact
the Department of Labor if you are in a self-insured group health plan or if you
have questions about COBRA or the Family and Medical Leave Act. See also COBRA and
Family and Medical Leave Act.
Usual, Customary and Reasonable Charge (UCR): The amount paid for
a medical service in a geographic area based on what providers in the area usually
charge for the same or similar medical service. The UCR amount sometimes is used
to determine the allowed amount.
Utilization Review: The review process aimed at helping HMOs and
insurance companies reduce health care costs by avoiding unnecessary care. The review
includes evaluating requests for medical treatment and determining, on a case-by-case
basis, whether that treatment is necessary.
Waiting Period: The time you may be required to
work for an employer before you are eligible for health benefits. Not all employers
require waiting periods. Waiting periods do not count as gaps in health insurance
for purposes of determining whether coverage is continuous. If your employer requires
a waiting period, your pre-existing condition exclusion period begins on the first
day of the waiting period. See also Pre-Existing Condition Exclusion Period.
Workers Compensation: A state-mandated program requiring
certain employers to pay benefits and furnish medical care to employees for on-the-job
injuries and to pay benefits to dependents of employees killed in the course of