Health and Accident Insurance Flashcards
This is the federal government’s group accident and health plan that covers servicemembers on active duty, retired service members, reservists, and the national guard. The program also provides coverage for military family members and survivors. This program was previously referred to as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
TRI-CARE
This is a dental plan that’s offered without any connection to an accompanying medical expense insurance contract.
Standalone Dental Plan
This is a policy that covers unusual hazards which are normally not covered under an ordinary accident and health insurance policy. For example, an actress who insures her legs for $1 million and a test pilot who flies an experimental airplane and obtains a policy covering his life while flying that specific airplane are both purchasing special risk policies.
Special Risk Policy
This is another name for government insurance. Put another way, this is insurance that’s provided through state and federal government insurance programs.
Social Insurance
Although sickness (or illness) is often considered an internal occurrence that becomes manifest, it may have a sudden onset or develop over time. Illnesses include both acute infections and chronic conditions.
Sickness
This type of policy typically lasts for as short as 90 days and may provide coverage for as long as one year. Short-term plans have always been a stripped-down version of major medical contracts. Today, they also provide less expensive, but limited, coverage for individuals who cannot afford ACA-compliant coverage on government exchanges.
Short-Term Medical Insurance
This plan pays a predefined benefit for specific services according to a published schedule.
Scheduled Dental Plan
These benefits include fillings, crowns, and other procedures that restore the natural function of teeth.
Restorative or Restoration Benefits
This is the maximum amount that’s payable under the terms of an Accidental Death and Dismemberment (AD&D) policy. The amount is payable as a death benefit and also represents the amount of insurance purchased. AD&D policies define this death benefit as the policy’s “principal sum.”
Principal Sum
This is the dental specialty that provides dentures to replace missing teeth, as well as other artificial dental devices.
Prosthodontics
This is a review process that’s conducted to determine whether services are medically necessary and covered under the policy. The predetermination of benefits is dependent on information that’s submitted before service, while the payment is dependent on information that’s submitted after service.
Predetermination of Benefits
This is a dental specialty that treats gum disease.
Periodontics
This form of dentistry specializes in treating children and adolescents.
Pediatric Dentistry
This is the direct cause of an insurable, economic loss.
Peril
This is the dental specialty that corrects the alignment of teeth with devices such as braces and retainers.
Orthodontics
This is a dental specialty that includes tooth extraction and other surgical treatments.
Oral Surgery
This is the dental specialty that performs tissue biopsy.
Oral Pathology
This type of policy covers a broadly defined category of perils that causes a form of loss. This type of policy will list the causes of loss that it specifically excludes from coverage. All other causes of loss (perils) are covered.
Open Peril Policy
This is a plan that provides a broad range of coverage. The contract divides covered care into several categories or levels of care. Using deductibles and co-insurance percentages that vary with the levels of care, the policy is able to control costs.
Non-Scheduled Dental Plan
This is the probability or risk of getting ill or becoming disabled.
Morbidity
This insurance pays benefits for doctors’ fees associated with services commonly rendered in a hospital, along with hospital costs and basic outpatient services.
Medical Expense Insurance
This insurance covers the cost of caring for individuals who have lost the ability to complete the daily tasks associated with living independently.
Long-Term Care Insurance
