chapter 13 Flashcards
pays benefits for nonsurgical doctors’ fees commonly rendered in a hospital; sometimes pays for home and office calls.
medical expense insurance
is a short-term policy purchased on an interim basis typically when in between jobs or waiting for a new policy to start.
interim coverage
is the purest form of accident insurance. It provides the insured with a lump-sum benefit amount in the event of accidental death or dismemberment under accidental circumstances.
Accidental death and dismemberment
designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare.
Patient Protection and Affordable Care Act
give the insurer the option to terminate the policy on a date specified in the contract. If the insurer decides to renew (not cancel) the policy, they also have the option (and usually choose to) increase the premiums on the anniversary date.
optionally renewable policies
benefit arrangements in which employees can pick and choose from a menu of benefits, thus tailoring the benefits package to their specific needs.
cafeteria plans
form of disability income coverage designed to pay necessary business overhead expenses, such as rent, should the insured business owner become disabled.
Business Overhead Expense Insurance
are agreements between business co-owners that provides that sharesowned by any one of them who becomes disabled shall be sold to and purchased by the other co-owners or by the business using funds from disability income insurance.
Disability Buy-Sell plans (disability buy-out agreement)
provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs.
Health Insurance Portability and Accountability Act (HIPAA)
allows a policy owner, before an original insurance policy expires, to elect to have a new policy issued that will continue the insurance coverage.
conversion privilege
previous coverage under another insurance plan when there has not been a break in coverage of 63 days.
credible coverage
federal legislation which extends group health coverage to terminated employees and/or their families at the individual’s expense, for up to 18 months.
COBRA
provide health insurance coverage to members of an association or professional society. I
Franchise Health Plans (wholesale plans)
the unforeseen, unexpected, unintended cause of an accident.
accidental means
policies that use the accidental bodily injury provision (sometimes called the results provision) required that the result of the injury has to be unexpected and accidental.
accidental results
amount payable as a death benefit.
The Principal Sum under an AD&D
another form of payment payable under an AD&D policy and is the amount payable for the accidental loss of sight or accidental dismemberment
capital sum
provides coverage for specific kinds of accidents or illnesses, such as injuries received as a result of travel accidents or medical expenses stemming from a specified disease.
limited risk policies
covers unusual hazards normally not covered under ordinary accident and health insurance.
special risk policies
specifies that the partnership is obligated to buy out the ownership interest of the deceased partner.
entity plan
specifies that the agreement will exist between the partners themselves and not between the partnership
cross-purchase plan
limits the portion of premium dollars health insurers may spend on administration, marketing, and profits.
Medical Loss Ratio (MLR)
