Health Insurance: Cram Course # 3 Flashcards
Health Insurance policies that provide specialized limited coverage, such as AD&D and dread disease.
Limited Policies
In health insurance, individuals covered by prepaid health plans. Synonymous with member.
Subscriber
Medical Providers are paid a set amount per month regardless of how many patients they treat. Synonymous with prepaid basis.
Service Basis
Medical providers are paid for each service they provide.
Fee-for-Service
Insurance designed to protect against the severity of financial loss due to illness, disease, short-or long-term disability, wages lost while ill or disabled, and medical expenses.
Health Insurance
Health insurance is provided by private commercial carriers and the government. Health insurance provided by the government is also referred to as social insurance and includes programs such as:
- Medicare
- Medicaid
- Tricare
Notice of claims must be given to the insurer within _____ of loss. If the insurer does not provide claim forms within _____ of receiving notice, the insured may submit proof of loss on any form.
- 20 days
- 15 days
A standard provision for group life and health insurance, stating that a grace period of at least 31 days is allotted for nonpayment of premium during which period the policy remains in force.
Grace Period
__________ requires a disabling condition return within a certain period of time __________ to be an extension of prior disability and not require another elimination period.
- Recurrent disability
- usually 90 days
A ___________ is the time between the __________ date of the policy and date coverage begins.
- Probationary period
- Effective
Payments the insured makes for benefits or services provided under the policy coverage. Sometimes called “copays,” these fixed-dollar payments are usually small ranging from $5 to $40.
Copayments
The insurer pays an amount for each procedure or treatment based on the average charges in that geographic area. Payment method for nonscheduled plans.
Usual, Reasonable, & Customary
How must an insured die in order for the beneficiary to receive Double Indemnity?
By accident (within 90 days of accident)
_________ These policies provide the insured the right to continuation of coverage by making timely payment of premiums. No changes in coverage or premiums are permitted without the insured’s consent.
Noncancelable
_________ policies provide continuation of coverage to a specified age subject to payment of premiums, but allows premium increases by classes of insureds.
Guaranteed Renewable
These policies allow the insurer the right to not renew for any reason specified in then policy and premiums can be increased.
Conditionally Renewable
_________ policies allow the insurer the right to not renew for any reason, and premiums can be increased.
Optionally renewable
These policies allow the insurer to cancel the policy at any time with notice, provided the insurer returns all unearned premiums.
Cancellable
What is the rider called that allows the insured to buy additional amounts of insurance without proof of insurability?
Guaranteed Insurability Rider
In how many days must the death occur?
- 90 days, after that they died from complications and Double Indemnity will not pay.
What ages must the insured be for the Guaranteed Insurability Rider?
25-40
A medical condition, whether physical or mental, resulting from accident or sickness preventing a person from being able to work.
Disability
Optional provision in health insurance policies which states the length of time between when sickness, accident, or disability begins and when benefits become payable. Often referred to as a “time deductible.”
Elimination Period
___________ is a condition such as loss of sight, hearing, speech, or loss of use of arms or legs, which qualifies as total disability, regardless of ability to work.
Presumptive disability
___________ is the inability to perform one or more duties or the inability to work full-time. Partial disability benefits pay the portion of lost income (usually 50% of total disability benefits) for up to 6 months.
Partial Disability
___________ is when the insured returns to work after total disability, but is unable to perform some of his prior duties. Residual disability pays the difference in the insured’s income before and after disability or 50% of total disability benefits.
Residual Disability
__________ is a condition for which the insured is not expected to recover, while __________ prevents working during recovery or rehabilitation, but the insured is expected to recover.
- Permanent Disability
- Temporary Disability
__________ restricts the insured to indoors, while __________ allows mobility.
- Confining disability
- Nonconfining disability
