Glossary Terms S-Z

Question 1

Schedule of Benefits

Answer 1

Schedule of Benefits is a one-page summary of insured’s current coverage. This is included in the complete Fulfillment Package, or can be sent on its own. Insured’s premium is not included on this document. The date on the SOB is the date of the last change, if no change was ever made it would be the origination of the policy date.

Question 2

Skilled Care

Answer 2

• Care for people with intensive medical needs.
• Typically provided or supervised by a registered nurse (RN.) or rehabilitation professional, such as a physical therapist.
• Provided under a doctor’s order.

Question 3

Situs State

Answer 3

• State where group policy (master policy) is filed for group.
• Generally, laws of situs state govern how master policy/contract is issued.
• Situs state for a group (employer, association), is most commonly state where main group office is located,

Question 4

Surviving Spouse

Answer 4

Legal spouse of a deceased eligible employee or deceased eligible retiree

Question 5

Total Lifetime Benefit

Answer 5

• Total amount of money in benefits that MetLife will pay for charges incurred for covered services
• Not including initial care advisory visit and transition expense benefit.
• Shown on insured’s schedule of benefits.
• Changes if daily benefit is changed.

Question 6

Underwriting

Answer 6

Medical screening process used to determine insurability