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   Transfers are recorded at the time of the actual payment, not at the time of the events that create the related claims and liabilities (see under accrual basis). For example, if, for whatever reason, the old age pension for the month of December 2002 is paid only on January 2003, the year recorded on an accrual basis would be 2002 while the date would be recorded as 2003 on a cash basis. [ILO,694]
See: accrual basis

   Benefit provided in cash such as income replacement and income support benefits, lump-sum payments from provident funds, allowances and other cash payments which are not reimbursements (i.e. which do not require beneficiaries to show evidence of expenditure). [ILO, 694]
Synonym: cash transfer

   See: third-party payment

    Regular non-contributory payment of money provided by government or non-government organizations to individuals or households (generally the women), with the objective of decreasing chronic or shock-induced poverty, addressing social risks and reducing economic vulnerability. [DFID, IDS, Devereux, 2005]

Synonym: cash benefit
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   Contingency that affects a large segment of the covered population, such as epidemics, and/or those for which the unit costs are high, such as very costly hospitalizations. The occurrence of catastrophic risks may jeopardize the financial viability of a health micro-insurance scheme. [ILO-STEP, 144]

   An employee of the civil service. [ILO,694]

   Period during which a benefit is received. Claims are completed if the receipt of the benefit has ended before or by the end of the reference period. Claims are ongoing if the receipt of the benefit has not been ended by the end of the reference period. [ILO,694]

   The portion of the cost or quantity utilized of a covered health service that is not borne by the health micro-insurance scheme.
Example: If the scheme covers 100 per cent of consultation fees up to a maximum of 400 Monetary Units (MUs) per consultation, and if the cost of a consultation is 600 MUs, then the amount borne by the scheme is 400 MUs and the amount of the co-payment is 200 MUs.
The introduction of co-payments enables a health micro-insurance scheme to reduce its costs, provided that the average amount for which the scheme is liable is lower as a result, and that insured persons, who must "pay out of their own pockets", are encouraged to limit their consumption of health care to what is strictly necessary. Notwithstanding, if the levels of co-payment are too high, the scheme may fail at ensuring the financial accessibility of health care for all persons. [ILO-STEP, 144]
For examples of co-payments see: flat-rate benefit; numerical deductible; monetary deductible; maximum number of days, cases or sessions; percentage co-payment
Synonym: cost-sharing (India)

   The set of legislative texts and application decrees governing insurance practices in a given country.
Examples: Some countries have a mutual benefit insurance code that governs the practices of mutual organizations or an insurance code that governs those of commercial insurance companies. [ILO-STEP, 144]

   Synonym: premium collection

   A system for the provision of coverage against the financial consequences of certain risks, formalized by means of a contract managed by a profit-oriented insurance company. The contract is concluded between an insurer and an insured party (individual or group). In exchange for the payment of premiums, the insurer guarantees the insured party that it will provide a specified level of coverage for expenses resulting from the occurrence of a given risk: fire, flood, theft, accident, illness, loss of harvest, etc. [ILO-STEP, 144]

   Community-based social protection mechanisms include:

• Institutions that directly administer a community-based social protection scheme. Examples are mutual benefit societies, microinsurance schemes, trade-union based schemes, cooperatives, associations, micro-finance institutions, etc.
•  Institutions that facilitate the implementation of a statutory or community-based social protection mechanism. Examples are civil-society and trade organizations such as agricultural or other cooperatives, farmers organizations, informal economy organizations, or sectoral associations of workers that play a role of intermediary between the social security scheme and their members

   See: claim

   A statutory and compulsory system through which the general community assumes responsibility for the health care costs of individuals as part of a State-run universal social security scheme. [ILO-STEP, 144]

    The patient's obligation to seek consultation from a health facility at a given level before being entitled to receive treatment at a higher level. The doctor or nurse at the first health facility refers the patient to the higher level.
Example: In order to be admitted to a district hospital, covered persons are required to have undergone consultation at a health centre and to have been "referred" (or recommended to proceed) to the next higher level. [ILO-STEP, 144]
See also: level of health infrastructure (or level of the health pyramid)

   An invoice that a health facility, which has concluded a third-party payment agreement with a health micro-insurance scheme, sends to the scheme at regular intervals in order to obtain payment. The consolidated invoice lists the charges for treatment delivered to protected persons during a given period. It enables the scheme to pay the provider, after having checked that the information on the invoice is consistent with the corresponding guarantee letters and treatment certificates. [ILO-STEP, 144]

    Context: utilization of health services

   Rule defining the rights and obligations of the scheme with respect to members and those of members with respect to the scheme. In the case of a mutual organization or an association, the contractual rules are contained in the internal rules. In the case of a health micro-insurance scheme that does not provide for the participation of members in the scheme's management, the contractual rules are contained in the insurance contract. [ILO-STEP, 144]

   Entitlement to a benefit is based on contributions from insured persons and/or their employer. [ILO,694]

    ILO conventions are conceived as models or sets of firm criteria for the preparation and formulation of national policies and national legislations.

   An autonomous association of persons united voluntarily to meet their common economic, social and cultural needs and aspirations through a jointly owned and democratically controlled enterprise. [Excerpt from ILO Recommendation 193 concerning the Promotion of Cooperatives, 2002.]

   A policy or practice used to obtain payment from patients for all or part of the cost of the health services provided to them. [ILO-STEP, 144]

   The financial compensation provided by the health micro-insurance scheme to insured persons for contingencies (or risks) defined in the insurance contract or the internal rules up to a prescribed limit. Compensation may be made through the reimbursement of members or through the application of a third-party payment mechanism. [ILO-STEP, 144]