Medical Plans Flashcards
Accidental bodily injury
an unforeseen and unintended injury that resulted from an accident rather than a sickness
Cafeteria plan
type of employee benefit plan that allows insureds to choose between different types of benefits
Cancellation
termination of an in-force insurance policy, by either the insured or the insurer, prior to the expiration date shown in the policy
Comprehensive coverage
health insurance that provides coverages for most types of medical expenses
Deductible
a specified dollar amount that the insured must pay first before the insurannce company will pay the policy benefits
Lump sum
a payout method that pays the beneficiary the entire benefit in one payment
Nonrenewal
termination of an insurance policy at its expiration date by not offering a continuation of the existing policy or a replacement policy
Riders
added to the basic insurance policy to add, modify, or delete policy provisions
Sickness
an illness, which first manifests itself while the policy is in force
Tax exempt
not subject to taxation
Taxable
subject to taxation
Underwriting
risk selection and classification process
Fee-for-service Plans
providers receive a payment for their billed charges for each service provided
Prepaid Basis
provide medical and hospital benefits in the form of service rather than dollars
Specified Coverage Policies
are those that insurance policies that limit coverage to one illness or one limiting group of coverages, e.g., cancer policies, prescription drug coverage, dental coverage, and other limited plans
Comprehensive Care Policies
are those plans that provide coverage for most types of medical expenses
What does HMO stand for?
Health maintenance organizations
What does PPO stand for?
Preferred provider organization
Medical Expense Insurance
Basic hospital, surgical, and medical policies, and major medical policies are commonly known as
They provide benefits for the cost of medical care that results from accidents or sickness
3 Basic coverages
- Hospital
- Surgical
- Medical
usually called first dollar coverage (usually do not require the insured to pay a deductible.
usually have more limited coverage than the Major Medical Policies