2 - Accident & Health Policies Flashcards
4 commonly accepted definitions of disability
- permanent total
- temporary total
- permanent partial
- temporary partial
permanent total
-will not work again
temporary total
-after a given period of time will likely return to work
permanent partial
-permanent injury but can return to work or be retrained
temporary partial
-will return to work after recovery
Definitions of Total Disability
- Own Occupation
- Any Occupation for which the insured is reasonably suited by reason of education, training or experience
- Any Occupation
- Combination Definition
- Disability Income Presumptive Disability
Most expensive definition?
-Own Occupation
Partial Disability Rider
-capped at 50% of monthly benefit
Residual Disability Rider
-provided the insured with a benefit in proportion to the loss of income
Recurrent Disability Provision
-if person has a relapse within a stipulated time after returning to work it will be treated as a continuation of same disability
Elimination (waiting) Period
- time where no benefits will be paid and disability must continue past
- 30 day increments
Probationary Period
- time period where no benefits will be paid for sickness
- 30 days or less
Short Term Disability
- benefit period between 3 months to 2 years
- waiting period of 0-14 days
Long Term Disability
- benefit periods for more than 2 years
- waiting period of at least 30 days
Non-Occupational Policy
-provide coverage for disabilities that resulted from other than the insureds employment
Full (Occupational) Coverage Policy
-provide for losses regardless of the time and location of the covered loss
Common DI Exclusions
- war/military
- self-inflicted
- attempted suicide
- criminal activity
- mental illness or drug addiction
- preexisting condition
- if worker’s compensation applies
Cost of Living Adjustment
- rider that provided automatic adjustment to benefits to keep pace with annual inflation numbers
- capped at 70% of income
Guaranteed Insurability Rider
-allows the insured to purchase additional amounts of DI coverage without evidence of insurability
Accidental Death & Dismemberment Rider
-pays benefit in the event death/dismemberment occurs from accident
principal sum
-amounts paid for accidental death
capital sum
-benefits for dismemberment
Basic Medical Expense Insurance
-traditional health insurance policy that provides very basic coverage
Difference between BMEI and MMEI?
-MMEI has deductibles, coinsurance and high benefit limits
per injury or per sickness deductible
-per occurence
cumulative deductible
-dollar amount to be paid by the insured during a state time period
family maximum deductible
-all expenses used by family members contribute to satisfying the deductible
Stop Loss Provision
-policy will pay all of covered expenses after a stated dollar amount
Carryover Provisions
-if insured has a claim in the last quarter of a year and has not had any claims in the previous 3 years can apply the amount to the next years deductible
HMO
-Health Maintenance Organizations
PPO
-Preferred Provider Organizations
Comprehensive Major Medical
-single policy that combines BMEI and MMEI
