16) Health and Disability
About this set
Created by:
ehsanders on May 18, 2010
Subjects:
California Fire & Casualty Insurance Agent
Log in to favorite or report as inappropriate.
Order by
60 terms
Terms | Definitions |
|---|---|
 Morbidity | The probability or frequency of accident or sickness within a given group of people. |
| Grace period | The period of time after a premium is due in which a payment may still be made without a lapse in coverage. |
| Morbidity Table | A table showing the statistical chances of being disabled. |
| Elimination period | A type of "deductible" found in disability income policies which refers to the period of time that must expire after the onset of an accident or illness before benefits are payable under the policy. |
| Cancelable | A provision allowing the insurer to cancel the policy at any time or at the end of a policy period with no guarantees of continuation of the policy. |
| Non-Cancelable | The insurer cannot cancel the policy other than for non-payment and can increase premiums only by class. |
| Stop-Loss Provision | The limit of out of pocket expenses the insured will incur during a policy period. The insurance company pays 100% of the remaining expenses. |
| Waiver of premium | The insurer waives the premium for the period of disability. |
| Waiting period | The time that must elapse before benefits begin, during which time the policy is in effect, but no benefits will be paid. |
| Deductibles | This is the amount the insured must pay before expenses will be paid under the policy. |
| Corridor deductible | This is the amount the insured must pay after the "basic medical expense" policy and before the "major medical" policy begins. |
| Flat deductible | A stated amount the insured must pay before benefits begin. |
| Integrated deductible | This means that the deductible may be satisfied under the basic medical expense plan, simultaneously satisfying the supplementary major medical plan deductible. |
| Extension of benefits | In group insurance plans, when a policy is terminated, this extension provides benefits for up to 12 months for any totally disabled employee or dependent, when claimed prior to termination. |
| Pre-Existing Conditions | Prior conditions for which the insured received or should have received medical advice or treatment before the date of application. |
| Guaranteed Renewable | A life or health insurance policy that cannot be changed unless it's changed for an entire class of people. |
| Coinsurance Clause | This provides for sharing expenses between the insured and the insurer on a major medical plan. |
| C- payments | Typically, a percentage of the cost of care paid by the insured. |
| Preferred Provider Organization | A PPO is a form of managed care closest to an indemnity plan. A PPO has arrangements with doctors, hospitals, and other providers of care who have agreed to accept lower fees from the insurer for their services. |
| Health Maintenance Organization | HMOs are the oldest form of managed care plan, including preventive care, for a set monthly fee. |
| Point-of-Service plan | Many HMOs offer an indemnity-type option known as a POS plan. |
| Health Savings Account | Money is kept in this account which goes with the employee if he or she leaves the company. |
| Flexible spending account | This allows an employee to set aside pre-tax dollars to pay for qualified health care expenses. |
| Health reimbursement arrangement | An HRA is a program where "health reimbursement accounts" is associated with a Health Care Plan. |
| Blanket policy | A blanket policy is designed to cover members of a certain group taking part in a specific shared activity. |
| Occupational policy | This will cover an accident that occurs either on or off the job. |
| Non-occupational policy | This will not cover claims that arise from job related accidents. |
| Travel accident | Travel accident insurance provides a large amount of coverage for a low premium. |
| Specified and Dread disease | These policies cover a specific catastrophic illness such as cancer. |
| Hospital Indemnity | This type of insurance pays a specified amount of cash benefits for each day that you are hospitalized, generally up to a designated number of days. |
| Basic Medical Expense policies | These three types of coverage pay the very first dollar and do not have a deductible. |
| Basic Hospital Expense | This takes care of expenses incurred when someone is confined to a hospital. |
| COBRA | This law provides health insurance coverage for someone who is between jobs. |
| Undue hardship | This is defined as an action requiring significant difficulty or expense in light of factors such as an employer's size, financial resources, and the nature and structure of the operation. |
| Major Risk Medical Insurance Program | MRMIP offers limited health insurance benefits to California residents who are unable to purchase health insurance due to a pre-existing medical condition. |
| Health Insurance Counseling Advocacy Program | HICAP is a state and federally funded program for Medicare beneficiaries, their families, and anyone who needs to know about Medicare. |
| Total disability | Own occupation and Any occupation. |
| Own occupation | Disability means the inability to work at your regular occupation - that is, to perform the material and substantial duties of your occupation. |
| Any occupation | Disability means the inability to work at any occupation. |
| Modified Own occupation | Disability means the inability to perform the duties of one's own occupation and not working in any occupation. |
| Partial disability | This means that as a result of the injury or sickness you are able to perform one or more but not all of the duties of your own or any other occupation on a full-time or part-time basis, or, you are able to perform all of the duties of your own or any other occupation only on a part-time basis. |
| Social Security | This pays benefits to people who cannot work because they have a medical condition expected to last at least one year or result in death. Social Security uses the following five-step process to decide if you are disabled or not: 1) Are you working? 2) Is your medical condition severe? 3) Is your medical condition on the list of impairments? 4) Can you do the work you did before? 5) Can you do any other type of work? |
| Probationary period | This is a period of time before coverage goes into effect. |
| Benefit period | The length of time that the monthly disability benefit payments will occur for each disability after the elimination period. |
| Loss of time and duties definition | This means that you must be out of work a certain percentage of the time, and if you're back at work your benefits may stop or be related to the amount of time you spend at work. |
| End-stage kidney disease | End stage kidney disease is a complete or near complete failure of the kidneys to function to excrete wastes, concentrate urine, and regulate electrolytes. This is also called End-stage renal disease. |
| Original Medicare Plan | This is a fee for service plan managed by the Federal Government. |
| Medicaid | This is the nation's major public health insurance program for low-income Americans, financing health and long-term care services for over 52 million people, including children and many of the sickest and poorest in our nation. |
| Medi-Cal | This is what the Medicaid program is called in California. People that are eligible include children under 21 years of age, persons 65 years of age or older, disabled and blind persons, pregnant women, families where at least one child is under 21 and at least one parent is absent, disabled, unemployed or working, and anyone who is eligible for CalWORKS. |
| Medicare Part A | This is a mandatory type of hospital insurance provided by Medicare. |
| Medicare Part B | This is voluntary, but only for individuals aged 65 or older. Enrollment into this program can be delayed when employer coverage is primary due to the active employment of the individual (ESRD), spouse, or parent (disabled dependent). |
| Medicare Part C | This is a voluntary program providing options to enroll in a Medicare managed care program called the Medicare Advantage program. |
| Medicare Part D | This provides a Medicare outpatient prescription drug benefit. |
| Participating providers | Participating providers have agreed to submit all their Medicare claims on an assigned basis. |
| Non-participating providers | Also called "Medicare providers" may choose whether to accept assignment on each individual claim. |
| Allowable Charge | The charge on which Medicare bases its benefits. |
| Customary Charge | The average amount charged in a specific area between July 1st and June 30th of the previous year. |
| Prevailing Charge | The amount based on the area where the insured lives. |
| Medicare Select Plans | Medicare's SELECT Plans are Medicare supplemental health insurance products. |
| Open Enrollment Period | This period provides Medicare beneficiaries with one opportunity to enroll in, disenroll from, or change a Medicare Advantage plan. |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.