Term
| major medical policies have what on the amounts paid for certain services that may apply each year, or there may be lifetime (aggregate) limits |
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Definition
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Term
| examples include limits on home health care, hospice care, treatment for alcoholism and drug addiction, routine physical exams, and care in a skilled nursing facility |
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Definition
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Term
| most individual major medical plans have incorporated elements of managed care in the |
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Definition
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Term
| a generic term for medical expense plans that provide benefits to insureds in a cost effective manner |
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Definition
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Term
| physicians, hospitals, and other health-care providers who are part of a plan network and agree to provide medical services to plan members at discounted fees |
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Definition
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Term
| insured who are out of the network for care must pay higher out-of-pocket costs for the care received w/ |
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Definition
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Term
| allows all eligible persons under the age of 65 to establish health savings accounts an receive |
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Definition
| favorable income-tax treatment |
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Term
| a tax-exempt or custodial account established exclusively for the purpose of paying qualified medical expenses of the account beneficiary who is covered under a high-deductible health insurance plan |
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Definition
| health savings account (HSA) |
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Term
| a high-deductible health insurance policy that covers catastrophic events, and an investment account from which the account holder can withdraw money tax-free for medical costs |
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Definition
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Term
| you must be covered by a high-deductible health plan and must not be covered by any other comprehensive health plan that is not a qualified high-deductible plan |
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Definition
| eligibility requirement of HSA |
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Term
| you must not be eligible for medicare |
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Definition
| eligibility requirement of HSA |
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Term
| you must not be claimed as a dependent on another person's tax return |
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Definition
| eligibility requirement of HSA |
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Term
| insured who are out of the network for care must pay higher out-of-pocket costs for the care received w/ |
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Definition
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Term
| the patient must require care in skilled nursing facility, and only up to 100 days are covered and custodial care is excluded all together |
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Definition
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Term
| most elderly are not eligible for long-term care under the |
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Definition
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Term
| most sold today are tax-qualified, which meet certain standards for favorable tax treatment under the Health Insurance Portability and Accountability Act (HIPAA) |
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Definition
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Term
| nontax-qualified policies fail to meet the |
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Definition
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Term
| facility-only policies, home health care only policies, comprehensive policies |
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Definition
| three categories of long-term care policies |
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Term
| typically covers care in a nursing home, assisted living facility, alzheimer's facility, or hospice as long as the insured satisfies the benefit trigger |
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Definition
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Term
| covers car received outside of an institution and typically covers home health care, adult day care, and respite care |
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Definition
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Term
| a benefit that provides occasional full-time care to an insured who is receiving home health care services, which allows a caregiver to take a needed break |
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Definition
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Term
| typically covers care in a nursing home, assisted living facility, and hospice and also makes available optional benefits for home health care and adult day care |
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Definition
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Term
| generally provide for a care coordinator who evaluates the various options for providing care and recommends the most appropriate services for an insured |
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Definition
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Term
| purchasers of long-term care insurance have a choice of daily benefits, which typically range from $50 to $300 or more for each |
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Definition
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Term
| the daily benefit paid for home health care may be less than the benefits paid for |
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Definition
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Term
| most long-term care policies are policies which reimburse the insured for actual charges up to some specified daily limit |
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Definition
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Term
| many insurers offer long-term care policies with what which provide a total dollar amount that can be used to pay for the different types long-term care services |
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Definition
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Term
| a waiting period during which time benefits are not paid |
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Definition
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Term
| can range from zero to 365 days |
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Definition
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Term
| a longer elimination period can substantially reduce |
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Definition
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Term
| tax qualified policies have two |
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Definition
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Term
| determine whether the insured is chronically ill and eligible for benefits |
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Definition
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Term
| the insured must meet only one of the two triggers to |
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Definition
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Term
| the first trigger requires the insured to be unable to perform a certain number of |
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Definition
| activities of daily living (ADLs) |
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Term
| eating, bathing, dressing, transferring from a bed to a chair, using the toilet, and maintaining continence |
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Definition
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Term
| the second trigger is that the insured needs substantial supervision to be protected against threats to health and safety b/c of |
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Definition
| severe cognitive impairment |
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Term
| non-tax qualified policies often have more liberal eligibility requirements and make benefits available if a |
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Definition
| medical necessity trigger is met |
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Term
| means that benefits can be paid if a a physician certifies that long-term care is needed even if the insured does not meet any of the benefits triggers |
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Definition
| medical necessity trigger |
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Term
| can gradually erode the real purchasing power of the daily benefit |
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Definition
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Term
| protection against inflation is especially important if the policy is purchased at a |
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Definition
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Term
| one method to protect against inflation is is allowing insureds to increase the daily benefit each year based on increases in the |
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Definition
| consumer price index (CPI) |
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Term
| another method to protect against inflation is to automatically increase the initial daily benefit each year at |
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Definition
| some specified rate, such as 5% compounded over the life of the policy |
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Term
| the long-term care policies sold currently are guaranteed |
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Definition
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Term
| means once issued, the policy cannot be canceled, but rates can be increased for the underwriting class in which the insured is placed |
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Definition
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Term
| disability-income insurance is another important form of |
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Definition
| individual health insurance |
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Term
| provides income payments when the insured is unable to work b/c of sickness or injury |
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Definition
| disability-income insurance |
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Term
| the amount of disability-income insurance you can buy is related to your |
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Definition
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Term
| to prevent overinsurance and to reduce moral hazard an malingering, most insurers limit the amount of insurance sold to no more than |
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Definition
| 60 to 80 percent of your gross earnings |
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Term
| the complete inability of the insured to perform each and every duty of his or her own occupation |
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Definition
| most liberal definition of total disability |
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Term
| the complete inability to perform the duties of any occupation for which the insured is reasonably fitted by education, training, or experience |
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Definition
| more restrictive definition of total disability |
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Term
| the inability to perform the duties of any gainful occupation |
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Definition
| definition of total disability commonly used for hazardous occupations where a disability is likely to occur |
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Term
| you are considered disabled if your income is reduced as a result of sickness of accident |
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Definition
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Term
| a disability-income policy containing this definition typically pays a percentage of the maximum monthly benefit equal to the percent of earned income that is lost |
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Definition
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Term
| for some initial period of disability, such as two to five years, total disability is defined in terms of the insured's own occupation. after the initial period, of disability expires, the most restrictive definition applies. |
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Definition
| combination of liberal and restrictive definitions of total disability that most insurers use |
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Term
| a total disability is presumed to exist if the insured suffers the total and irrecoverable loss of sight in both eyes, to he total loss or use of both hands, both feet, or one hand and one foot |
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Definition
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Term
| the inability of the insured to perform one of more important duties of his or her occupation |
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Definition
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Term
| are paid at a reduced rate, for a short period of time |
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Definition
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Term
| partial disability in most policies must follow a period of |
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Definition
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Term
| newer policies frequently include what type of benefit, rather than a partial disability benefit, or this provision can be added as an additional benefit |
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Definition
| residual disability benefit |
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Term
| means that a pro rata disability benefit is paid to an insured whose earned income is reduced because of an accident or sickness |
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Definition
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Term
| the typical residual disability provision has a time and duties test that considers both |
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Definition
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Term
| means that you are engaged in your regular or another occupations, and your income is reduced b/c of an accident or sickness by at least 20% of your prior income |
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Definition
| alternative def for residual disability that considers only the loss of earned income |
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Term
| most insurers consider a loss of earned income in excess of 75 or 80 percent to be a loss of 100 percent, in which case the full monthly benefit for total disability is |
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Definition
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Term
| one major advtg of what is the payment of a partial benefit if the insured returns to work but earnings are reduced |
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Definition
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Term
| the length of time that disability benefits are payable after the elimination period is met |
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Definition
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Term
| the longer the disability lasts, the less likely the disabled person will |
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Definition
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Term
| if the insured is totally disabled for 90 days future premiums will be waived as long as the insured remains disabled |
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Definition
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Term
| this renewal provision gives the insured the least protection with respect to continuation of coverage |
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Definition
| optionally renewable policy |
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Term
| the insurer has the right to terminate a policy on an anniversary date, or in some cases, on a premium date |
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Definition
| optionally renewable policy |
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Term
| w/ the optionally renewable policy, the policy is renewable only with the consent of the |
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Definition
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Term
| instead of non renewal, the insurer may specify the conditions that must be met before the policy is renewed |
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Definition
| optionally renewable policy |
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Term
| one in which the the insurer guarantees to renew the policy to some stated age, however, the insurer has the right to increase premium rates for the underwriting class in which the insured is placed |
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Definition
| guaranteed renewable policy |
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Term
| the policy cannot be cancelled, and renewal of the policy is at the insured's sole discretion |
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Definition
| guaranteed renewable policy |
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Term
| a noncancellable policy provides the greatest protection to the |
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Definition
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Term
| a policy that cannot be cancelled. the insurer guarantees renewal of the policy to some stated age, and the premiums are guaranteed and connote be increased during that period |
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Definition
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Term
| allows the insured to keep the insurance in force by the timely payment of premiums until at least age 50, or if the policy is issued after age 44, for at least five years from the issue date |
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Definition
| noncencellable medical expense policy |
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Term
| to control adverse selection, individual medical expense policies usually contain some type of |
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Definition
| preexisting-conditions clause |
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Term
| a physical or mental condition for which the insured received treatment or that existed during some specified time period prior to the effective date of the policy |
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Definition
| preexisting-conditions clause |
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Term
| are not covered until the policy has been in force for a specified period, unless the condition is disclosed in the application and is not excluded by a rider |
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Definition
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Term
| usually applies to health conditions not disclosed in the application |
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Definition
| the preexisting-conditions exclusion |
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Term
| under this provision you are required to give written notice to the insurer w/in 20 days after a covered loss occurs or as soon as is reasonably possible |
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Definition
| notice of claim provision |
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Term
| under this provision, the insurer is required to send you a claim form w/in 15 days after notice is received |
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Definition
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Term
| under this provision, you must send written proof of loss to the insurer w/in 90 days after a covered loss occurs |
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Definition
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Term
| the time limit on certain defenses is a required provision and has the same effect as the |
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Definition
| incontestable clause in life insurance |
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Term
| states that after the policy has been in force for two years, the insurer cannot void the policy or deny a claim on the basis of misstatement in the application, except for fraudulent misstatements |
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Definition
| time limit on certain defenses |
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Term
| insure for the catastrophic loss, consider group health insurance first, purchase a policy that has a preferred provider network, don't ignore disability-income insurance, avoid limited policy, use deductibles and elimination periods to reduce premiums |
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Definition
| guidelines for shopping for individual health insurance |
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Term
| covers only certain diseases or accidents, pay limited benefits, or places serious restrictions on the right to receive benefits |
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Definition
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Term
| one example of a limited policy, pays a fixed daily or monthly cash benefit if you are admitted to a hospital |
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Definition
| hospital confinement indemnity policy |
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Term
| another example of a limited policy - covers only certain diseases listed in the policy, such as cancer, multiple sclerosis, or muscular dystrophy |
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Definition
| specified (dread) disease policy |
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