Individual health insurance policy provisions
Terms in this set (37)
policy including all the endorsements and any attached papers as well as photocopys
Time limit on certain defenses
the purpose of this provision is to limit the period of time in which an insurer may challenge the contract of deny a claim on grounds of material misrepresentation in the application
A period of time after the premium due date in which a policyholder is able to make a premium payment without the insurance policy coverage lapsing.
The workers compensation law in New York is a ?
This requires employers a choice between purchasing workers compensation insurance from the state is called?
monopolistic state funds
This gives employers a choice between purchasing workers compensation insurance from the state funds or a private insurance company?
competitive state funds
Are provided on a unlimited basis
What is the dollar limit on medical benefits?
There is no dollar limit
What is the income benefit amount given for lost wages
66 2/3 %
Death benefits include burial allowance and ?
Income benefits for a surviving spouse and/ or children
Under the death benefits how long are the children eligible for?
until age 18, or until age 23 if they remain full time students
would a minor child of the employer be covered under the disability benefits law?
Would an employee of an employer who elects to provide benefits by filing an application for voluntary coverage be covered under the disability benefits law?
Does the workers compensation law apply to all types of employment?
Who is not covered under the workers compensation laws?
volunteer workers , among farm labors ( who if paid under $1,200 in a year)
The workers compensation Board may require proof that the employer has/is?
Has a valid workers compensation insurance policy, Is legally except from having to obtain workers compensation coverage
The workers compensation law provides that a failure to secure the payment of compensation for five or less employees with in 12 months period constitutes as a?
Misdemeanor,punishable by a fine of not less than $1,000 but not more than $5,000
An employer must keep accurate records of the number of employees, classification, wages and accidents for their business for?
If a employer fails to secure coverage for 10 consecutive days to make the provision for payment of compensation may impose upon such employer an?
fines, penalty of $2,000 for each 10 day period of non-compliance
what is the NCCI stand for?
National Council on Compensation Insurance
The standard policy form cites four specific types of damages the insurer will pay where recovery is permitted by law , 3rd party over actions, consequential bodily injury,dual capacity and?
Care and loss or services
what was the former name for the Social security program?
Old age , survivors, disability and health Insurances
What is the Jones Act?
A federal law that allows members of ships crews to sue their employer or the ship owner at common law for injuries caused by the employer's or ship owners negligence
Congress passed this Act in 1908 before there were workers compensation statues and benefits?
Federal Employers Liability Act
The satisfaction of a five month waiting period is the requirement for ?
Social Security disability
Medicaid is a federal and state funded program for those whose income and resources are ?
Insufficient to meet the cost of necessary medical care
Before Medicaid will reimburse a patient for any nursing home costs he/she must?
1st pass certain income and asset limitation tests
To be eligible for either children's Medicaid or Child Health Plus the child must be under what age?
19 years old
When someone in a nursing home applies for Medicaid to pay nursing home expenses Medicaid looks back how far?
Medicare is ---- under specified conditions for services covered
in Part A what is it?
Is Part A benefits provided on a blanket basis?
Medicare A benefits do not cover private duty nurses, private rooms and?
Part B is?
Part B pays--- of the approved changes
Part B is also called?
supplemental medical insurance
Medicare Part C is formerly known as?