Health Insurance Today Chapter 11 (HIT)
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43 terms
Terms | Definitions |
|---|---|
 1. Activities of Daily Living | behaviors related to personal care typically include bathing, dressing, eating, and toileting, getting in or out of bed or a chair, and walking. |
| 2. Americans with Disabilities Act | act that protects the civil rights of individuals with disabilities |
| 3. Benefit Cap | - a maximum benefit amount pay for any one incident or any one year. |
| 4. Black Lung Benefits Act | act that provides compensation for minors with black lung. |
| 5. Casual Employee | - an employee, who is not entitled to paid holiday or sick leave, has no expectation of ongoing employment, and for whom each engagement with their employer constitutes a separate contract of employment. |
| 6. Coming and Going Rule | a rule that coverage for injuries sustained while an employee is commuting to and from work are generally excluded by most state workers' compensation laws. |
| 7. Disability and Health Team | a part of a new National Center on Birth Defects and Development Disabilities at the Centers for Disease Control and Prevention that focuses in promoting the health of people who are living with disabilities. |
| 8. Disability Income Insurance | a form of health insurance that replaces a portion of earned income when an individual is unable to perform the requirements of their job because of illness or injuries that is not work related. |
| 9. Earned Income | income from employment |
| 10. Egregious | - conspicuously negligent |
| 11. Employment Network | - a public agency or private organization that has agreed to provide services under the Ticket to Work Program guidelines. |
| 12. Exemption- | when a business organization is not require to purchase workers' comp insurance for its employees because of a specific classification of business type or the fact that it has a minimal number of employees. |
| 13. Federal Employment Compensation Act | act that provides workers' comp to nonmilitary federal employees. |
| 14. Federal Employee Liability Act | under this act, states in which railroads are engaged in interstate commerce are liable to injuries from their employees if they have been negligent. |
| 15. Financial Means Test | a detailed and comprehensive questionnaire that establishes financial need to receive SSI. |
| 16. Instrumental Activities of Daily Living | activities that usual include using the telephone, shopping, preparing meals, keeping house, doing laundry, doing yard work, managing personal finances, and managing medication. |
| 17. Interstate Commerce | trade that involves more than one state. |
| 18. Job Deconditioning | when the patient psychological or physically loses their ability to perform normal job duties at the previous level of expertise as a result form being absent from work. |
| Longshore and Harbor Workers' Compensation Act | act that provides workers' comp to specified employees of private maritime employers. |
| 20. Long-term Disability | helps replace income for up to 5 years or until disabled individual turns 65 |
| 21. Merchant Marine Act | act that provides seamen with the same protection from employer negligence the Federal Employment Liability Act provides railroad workers. |
| 22. Modified Own | occupation Policy- covers workers for their own occupation for as long as they are not gainfully employed elsewhere. |
| 23. No-fault Insurance | in workers' comp insurance, benefits are paid to the injured worker regardless of who is to blame for the accident or injury. |
| 24. Occupational Therapy | skill treatment for ill or injured individuals that facilitate their return to ordinary tasks around home or at work by maximizing physical potential through lifestyle adaptations, sometimes through the use of assistive devices. |
| 25. Ombudsman | an individual who is responsible for investigating and resolving workers' complaints against the employer or insurance company that is denying the benefits. |
| 26. Own-occupation Policy | covers workers who are unable to perform in the occupation or job that they were doing before the disability occurred. |
| 27. Permanent and Stationary | when a condition reaches a state of maximal medical improvement. |
| 28. Permanent Disability | the ill or injured employee's condition is such that it is impossible to return to work. |
| 29. Permanent Partial Disability | when a disability prevents the individual from performing one or more occupational functions, but does not impair their capability for performing less demanding employment. |
| 30. Permanent Total Disability | when the employee's ability to work at any occupation is totally and permanently lost. |
| 31. Progress or Supplemental Report | reports that a physician must file to keep the employer and the insurance carrier appraised of a patient's treatment plan, progress, and status in workers' comp cases. |
| 32. Protected Health Information | identifiable health information that is protected under the HIPPA Privacy Rule. |
| 33. Short-term Disability | coverage that pays a percentage of an individuals' wages or salary if and when they become temporarily disabled. |
| 34. Social Security Disability Insurance | - (1) a primary federal insurance program that protects workers from loss of income resulting from disability and provides monthly cash benefits to disabled workers younger than 65 and to certain dependents. (2) Insurance program for individuals who become unable to work. |
| Supplemental Security Income | a program established in 1972 and controlled by the Social Security Administration that provides federally funded cash assistance to qualifying elderly and disabled poor. |
| 36. Temporarily Disabled | when an individual is unable to work for a short time as a result of sickness or injury. |
| 37. Temporarily Disability | benefits in a category are paid so long as the physician's opinion concurs with that claim of status. |
| 38. Temporarily Partial Disability | when an injury or illness impairs an employee's ability to work for a limited time. |
| 39. Temporarily Total Disability | when a worker's ability to perform their job responsibilities is totally lost, but on a temporary basis. |
| 40. Ticket to Work Program | a volunteer program that gives certain individuals with disabilities greater choice in selecting the service providers and rehabilitation services they need to help them keep working or get back to work. |
| 41. Treating Source | provides the long-term medical information, which is normally required for every claim of disability insurance. |
| 42. Vocational Rehabilitation | is retraining or physical therapy that may be needed if an injury or illness results in the worker being unable to perform the usual duties of their occupation. |
| 43. Workers' Compensation | a type of insurance regulated by state laws that pays medical expenses and partial loss of wages for workers who are injured on the job or become ill as a result of job-related circumstances. |
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