Commercial Insurance (COMP. 6/ Chapter 12)

24 terms by MSJAYDA 

Ready to study?
Start with Flashcards

Create a new folder

Advertisement Upgrade to remove ads

Study guide for completing fee-for-service claims that are generally accepted nationwide by most commercial health insurance companies, including Athena, United Health Care, Prudential, Cigna, and others.

Commercial health insurance

Covers the medical expenses of individuals (private health insurance) and groups (employer group health insurance).

Automobile insurance policy

Is a contract between an individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific car-related financial losses during the term of the policy. Coverage typically includes the following; Collision, Comprehensivem, Emergency road service, liability, medical payments, personal injury protection, rental reimbursement, and underinsured motorist.

Medical adjuster

Reviews healthcare bills submitted to the insurance company for treatment of injuries sustained as the result of a motor vehicle accident to determine coverage.

Disability insurance

Covers reimbursement for income lost as a result of a temporary or permanent illness or injury. Disability insurance generally does not pay for healthcare services, but provides the disabled person with financial assistance.

Liability insurance

Is a policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries and lost wages, and, in many cases, remuneration (compensation) for the "pain and suffering" of the injured party. *health insurance benefits are secondary to liability insurance.

SSDI

Social Security Disability Insurance
Pays benefits to you and certain members of your familt if you are "insured," meaning that you worked long enough and paid social security income taxes.

SSI

Supplemental Security Income
Assistance to people with disabilities, pays benefits based on finacial need.

Base Period

Usually covers 12 months and is divided into 4 consecutive quarters. It includes taxed wages paid approximately 6 to 18 months before disability claim begins.

Subrogation

Refers to the contractual right of a third-party payer to recover healthcare expenses from a liable party.

Lien

Securing a debtor's property as security or payment for a debt.

EGHP

Employer group health insurance plan

Birthday Rule

States that the policyholder whose birth month and day occurs earlier in the calendar year holds the primary policy when each parent subscribes to a different health insurance plan.

NPI

National provider identifier

POS

Place of service

CLIA

Clinical Laboratory Improvement Amendments

Seconday health insurance

Plans provide coverage similar to that of primary plans

Supplemental health insurance

Usually cover only deductible, copayment, and coinsurance expenses.

PIP

Personal injury protection

Fee-for-service

Also known as indeminity insurance is traditional health insurance that covers a portion of services, such as inpatient hospitalizations or physician office visits with the patient paying the remaining costs.

High-risk pools

"last resort" health insurance for individuals who cannot obtain coverage due to a serious medical condition; certain eligibility requirements apply, such as refusal by at least one or two insurance companies.

Managed care

Health maintenance organization, preferred provider organization.

Association health insurance

Offered to members of a professional association and marketed to small business owners as a way to provide coverage to employees; however, these plans are subject to the same regulations as group health insurance plans and, therfore, are more risky.

EIN

employer identification number

SSN

social security number

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set