Types of Health Policies Flashcards
What is presumptive disability?
A provision found in most policies
What does Presumptive Disability specify?
The condition that will automatically qualify the insured for full disability benefits.
What does Presumptive Disability provide benefits for?
Dismemberment
Total and permanent blindness
Loss of speech or hearing
What does the Recurrent Disability provision specify?
The period of time of which an injury/illness will be considered as a continuation of a prior period of disability.
Is a recurrence under the Recurrent Disability provision considered a new period of disability?
No
If an illness/injury is considered recurrent is it subject to another elimination period?
No
What is a probationary period?
Waiting period in addition to elimination period
What does a probationary period apply to?
Sickness only
What is the Benefit Period?
The length of time that the monthly disability benefit payment will last for each disability after the elimination period.
What is Accidental Bodily Injury?
Damage to body is unexpected and unintended
Usually no more than what percentage of original earnings are rewarded to the disabled?
66%
When are Social Insurance Supplements (SIS) or Social Security Riders used?
When insured is eligible for SS but has a waiting period
If insured is denied SS
When amount payable under SS is less than amount payable under the rider (difference is paid)
Does the Business Overhead Expense reimburse lost income?
No
What is the elimination period for Business Overhead Expense?
15 - 30 days
How long can the benefits of the Business Overhead Expense last?
1 - 2 years
What does the Business Disability Buyout Policy specify?
How the business will pass between owners when one dies or becomes disabled.
What payment is used when receiving the benefit for the Business Disability Buyout Policy?
Lump sum
What does a Limited Risk Policy cover?
Defines specific risks in which accidental death or dismemberment benefits will be paid
What does a Special Risk Policy cover?
Only unusual types of risks that aren’t normally covered.
What does Medical Expense Insurance cover?
Basic hospital, surgical and medical.
Usually no deductible.
What does a Basic Hospital Expense Coverage cover?
Hospital room and board
Misc. hospital expenses
No deductible
What is limited in a Basic Hospital Expense Coverage plan?
Hospital room and board are limited to s set dollar amount per day for a max number of days
What does Basic Medical Expense Coverage cover?
Nonsurgical
What is Basic Medical Expense Coverage limited to?
Number of visits per day
Limit per visit
or limit per hospital stay
What does the Basic Surgical Expense Coverage cover?
Pays for cost of surgeons services
What is a surgical schedule?
List of types of operations covered and assigned dollar amounts
What is relative value?
Each surgical procedure is assigned a number of points, relative to max number of points.
Represents amount payable per point.
