Health Insurance And Health Insurance Products Flashcards
Accident and sickness insurance
Insurance against bodily injury, disability or death by accident or accidental means, or expense there of, or against disability or expense resulting from sickness, and the insurance relating there of.
Accident
A fortuitous event, unforeseen and unintended
Accident insurance
A form of health insurance against loss by bodily injury
Accidental bodily injury
Generally, traumatic damage to the body, or external origin, unexpected and by the injured person
Accidental means
A definition of injury that is based on the concept of contributory negligence.prohibited as a definition for Medicare supplement and long-term care policies
Administrative services only
The services provided by an inch or such as providing claim forms, processing claims, and making payments to healthcare providers
Blanket accident and health policy
An accident and health insurance policy that covers all of a class of persons not individually identified
Blanket medical expense policy
A policy or provision in a policy that pays all medical costs (including hospitalization, drugs, treatments, etc.) without exclusion of any term or maximum on any item. Includes a maximum aggregate benefit under the policy. Often written with a deductible amount.
Blue plan
Generic term for those insurers(usually on a service rather than reimbursement basis) Who are authorized to use the designation Blue Cross or Blue Shield and the insignia of either.
Cancelable
A contract of health insurance that the insurer may cancel at any time for no stated reason but with five days notice. Unearned premium’s must be refunded.
Comprehensive major medical
A plan of insurance that has a low deductible, high maximum benefits, and a coinsurance feature. It is a combination of basic coverage and major medical coverage which has virtually replaced separate hospital, surgical and medical policies with each having its own deductible requirements.
Conditionally renewable
A contract of health insurance that provides that the insured may renew the contract to a stated date or an advanced age, subject to the right of the insurance company to decline renewal only under conditions defined in the contract.
Deductible
A provision or clause and an insurance policy that the first given number of dollars or percentage of expense will not be reimbursed.
Disability benefit
The benefits payable for disability under a disability income policy or provision
Disability income insurance
A form of health insurance that provides periodic payments to replace income, actually or presumptively lost, when the insured is unable to work as a result of sickness or injury.
Double indemnity
Payment of twice the basic benefit event of loss resulting from specified causes or under specified circumstances.
Doughnut hole
The phase in which Medicare seniors must pay 100% of their prescription drug costs until they reach out-of-pocket expenses totaling a stipulated amount. The stipulated amount changes annually.
Dread disease policy
A policy, usually offering blanket coverage up to a very high maximum for certain specified diseases only, such as scarlet fever smallpox, polio, tetanus, etc.
Elimination Period
A loosely used term sometimes designating the waiting period And sometimes the probationary period
Group contract
A contract of insurance made with an employee or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare Association or employee benefit Association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.
Health insurance
Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense. The term health insurance is now used to replace such terms as accident insurance, sickness insurance, medical expense insurance, accidental death and dismemberment insurance. The form is sometimes called accident and health, accident and sickness, accident, or disability income insurance.
Health maintenance organization (HMO)
And organization of health providers. Each member pays a premium for which he receives medical care when desired. The emphasis is on preventative medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans.
Hospital benefits
Benefits payable when an insured is hospitalized.
Hospital indemnity or income policy
A policy paying a specific Dollar amount directly to the insured for every day hospitalized, usually beginning with the first day and payable for up to one year.
Hospital/surgical expense policy
A policy combining benefits of hospital and surgical coverages.
Hospitalization expense policy
A policy which covers daily hospital room and board charges and also covers miscellaneous hospital expenses such as x-rays. It also covers emergency treatment charges and many times will also include a surgical benefit.
Hospitalization policy
A policy that reimburses the policy owner for certain specified costs of hospital confinement.
Non-confining sickness
A sickness or disability that is not confined the insured indoors
Noncontributory
Any plan or program of insurance (usually group) for which the employer pays the entire premium and the employee contributes no part of the premium
Non-occupational policy
A policy or provision of a policy which excludes accidents occurring on the job, when such employment is covered by Worker’s Compensation.
Occupational accident
An accident occurring in the course of one’s employment and caused by hazards inherit or related thereto.
Occupational disease
Impairment of health caused by continued exposure to conditions inherent in a person’s occupation or a disease caused by unemployment or resulting from the nature of an employment
Occupational Hazard
A condition in an occupation that increases the peril of accident, sickness, or death there from.
Optionally renewable
A contract of health insurance in which the insured reserve the understood the right to terminate the coverage at any anniversary or, in some cases, at any premium due date, but does not have the right to terminate coverage between such dates.
Outpatient
A patient who is not a bed patient in the hospital in which he receives treatment.
Over insurance
A condition in which 1. More insurance is in force on the insured or the risk than the potential loss or 2. So much is in force as to constitute a moral or morale hazard (such as so much disability insurance being in force that it becomes profitable to become disabled.)
Partial disability
A condition in which, as a result of injury or sickness, the insured cannot perform all of the duties of his occupation but can’t perform some. Exact definitions ferry from policy to policy.
Permanent and total disability
Total disability from which the insured does not recover. When used as a definition and a policy (usually a life insurance policy rider), “permanent” is presumed after a stated period of time, commonly six months.
Preferred provider organization (PPO)
And organization of hospitals and physicians who provide, for a set fee, services to insurance company clients. These providers are listed as preferred and the insured may select from any number hospitals and physicians without being limited as with an HMO. Coverage is 100%, with a minimal copayment for each office visit or hospital stay. Contrast with health maintenance organization.
Prepaid hospital service plan
The common name for health maintenance organization plant (HMO). It provides comprehensive healthcare, usually by salaried personnel, for members who pay a flat fee for the services, whether outpatient or hospital treatment is needed.
Probationary period
A period of time between the effective date of the health insurance policy and the day coverage begins for certain conditions.
Reoccurring clause
A health insurance policy provision defining the duration of a period of time during which the recurrence of a condition will be considered a continuation of a prior period of disability or confinement.
Relative value schedule RVS
Shows the value of one medical procedure in relation to another.
Residual disability
That form of disability which becomes defined as partial disability when and insured has returned to work immediately following a period of total disability.
Salary savings plan
Insurance issued to individual employees whose employer agrees to deduct the premiums from their paychecks and remit to the insurance company.
Self-inflicted injury
And injury to the body of the insured inflicted by himself.
Self Insurance
Making financial preparations to me pure risks by appropriating sufficient funds in advance to meet estimated losses, including enough to cover possible losses and access to those estimated. Few organizations are large or dispersed enough to make this a sound alternative to insurance
Service plans
Plans of insurance or benefits are the actual service rendered rather than a monetary benefit, such as the benefits provided by Blue Cross and Blue Shield.
Short term disability income policy
A disability income policy with benefits payable for short-term, usually less than two years, as opposed to a long-term disability income policy.
Sickness insurance
A form of health insurance against loss by illness or disease. This form of health insurance provides benefits and event of loss occasioned by sickness (either illness or disease). Illness or disease does not include accidental bodily injury. Sickness insurance may provide benefits for loss of time for expense incurred by pregnancy.
Standard provisions
(1) provisions prescribed by state law that must appear and all policies issued in that jurisdiction. (2) provisions adopted by the NAIC to apply to group life insurance as minimum protection. They are required by law and most states. (3) formally, a set of prescribed provisions regulating the operating conditions of a health insurance policy by law in most jurisdictions between about 1912 and 1950. They are now superseded by uniform provisions for individual accident and health insurance policies which contain and NAIC model bill. These have been enacted in virtually all jurisdictions.
Subscriber
The insured, when speaking of prepaid hospital plans.
Total disability
A degree of disability from injury or sickness that prevents the insured from performing the duties of any occupation for remuneration or profit. The definition in any given case depends on the wording in a covering policy.
Uniform provisions
A set of provisions relating to the operating conditions of a health insurance policy that are specified by state law. Uniform provisions law is the national Association of insurance commissioners model law entitled, “Uniform Individual Accident and Sickness Policy Provisions Law.”
