Shared Flashcard Set

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Health Insurance
1
41
Insurance
Undergraduate 1
08/30/2017

Additional Insurance Flashcards

 


 

Cards

Term
Representation
Definition
A statement believed to be true to the best of one's knowledge
Term
Reinsurance
Definition
Insurance purchased by an insurance company from another insurance company as a means of risk management or spreading the risk
Term
Residual disability benefit
Definition
While not totally disabled, the policy will pay the insured a portion of his lost income if he is not able to work as much or is forced to work at a job that pays less
Term
Respite care
Definition
Type of health ore medical care designed to provide a short rest period for a caregiver
Term
Reasonable and customary charge
Definition
Charge for health care service consistent with the f=going rate of charge in a given geographical area for identical or similar services
Term
Recurrent disability provision
Definition
A disability income policy provision that species the period of time during which the reoccurrence of a disability is considered a continuation of a prior disability
Term
Proof of loss
Definition
A mandatory NAIC provision stating that the insured must submit a completed claim form with documentation of loss to the insurer within 90 days of the date of loss
Term
Prospective review
Definition
Insurer reviews all proposed nonemergency hospital admissions and requires approval before admission
Term
Peril
Definition
The reason for the loss(fire, wind, hail, and so forth)
Term
Preexisting condition
Definition
An illness or medical condition that existed before a policy's effective date
Term
Preferred provider organization
Definition
Association of health care providers, such as doctors and hospitals, who agree to provide health care to members of a particular group at a discounted rate
Term
Preferred, standard, substandard, or decline
Definition
The four ways risks are classified
Term
Presumptive disability benefit
Definition
Regardless if the insured is able to work, he is eligible for full disability benefits if he has complete loss of speech, hearing, vision or the loss of use of two or more limbs
Term
Primary insurance amount (PIA)
Definition
Amount equal to a covered worker's full Social Security retirement benefit or disability
Term
Principal sum
Definition
The amount under an AD&D policy that is payable as a death benefit if death is due to an accident
Term
Probationary period
Definition
A period of time between the issuance of a policy and the date coverage begins (sickness is not covered during this time)
Term
Partial disability
Definition
Illness or injury preventing insured from performing at least one or more, but not all, of the insured's occupational duties
Term
Own occupation
Definition
A definition of total disability. The insured must be unable to work at her own occupation. It is easier for the insured to receive benefits under policies using this definition
Term
Offer
Definition
This element of a contract is either made by the applicant (when an application is completed and premium is submitted) or is made by the insurance company (when no premium is submitted with the application)
Term
Open-panel HMO
Definition
A network of physicians who work out of their own offices and participate in the HMO on a part-time basis
Term
Notice of claims provision
Definition
Mandatory NAIC provision that describes the insured's obligation to provide notification of loss to the insurer within a reasonable period of time
Term
Nonscheduled plan
Definition
Pays on the basis of what is considered usual, customary, and reasonable in a certain geographical area and based on amount physicians in area usually charge for same of similar procedures
Term
Non-cancelable renewal provision
Definition
This renewal provision is most favorable to the insured as the insurer cannot cancel coverage (except for nonpayment of premium) nor increase the premium
Term
Non-disabling injury
Definition
Requires medical care, but does not result in loss of time from work
Term
Morbidity
Definition
The relative incidence of disability due to sickness or accident within a given group
Term
Misstatement of age or sex provision
Definition
If insured's age or sex is misstated in an application for insurance, the benefit payable is adjusted to what the premiums paid should have purchased
Term
Multiple employer trust (MET)
Definition
Several small groups of individuals that need life and health insurance but do not qualify for true group insurance band together under state trust laws to purchase insurance at a more favorable rate
Term
National Association of Insurance Commissioners (NAIC)
Definition
Association of state insurance commissioners active in insurance regulatory problems and in forming and recommending model legislation and requirements
Term
Medicare Part D
Definition
Private insurance coverage for prescription drugs which is subject to Medicare rules
Term
Medicare supplement policy
Definition
Health insurance that provides coverage to fill the gaps in Medicare coverage
Term
Medicare Part A
Definition
Hospitalization insurance that provides specified in-hospital and related benefits. Hospital admissions are subject to a deductible and possible co-pays
Term
Medicare Part B
Definition
Covers physicians and outpatient treatment, subject to a monthly premium, annual deductible and coinsurance
Term
Underwriting
Definition
A department found within an insurance company that reviews applications to evaluate risk and eliminates those that do not meet standards
Term
Total disability
Definition
Definition of disability where the insured is unable to work
Term
Utilization review
Definition
Managed care organizations may control hospitalization costs by methods:
-Prospective review:Pre-approval before admission
-Concurrent review: Continuing review during the period of hospitalization
Term
Unilateral
Definition
A unique characteristic of insurance, stating insurers are required by law to pay legitimate claims where the policy owner is not required by law to pay a premium. Only insurer makes legally enforceable promise
Term
Stop-loss provision
Definition
Limits the maximum out-of-pocket expense an insured must pay for health care and once the threshold has been met, the health insurance policy covers all expenses for the remainder of the year at 100%
Term
Substandard risk
Definition
Person sho is considered an under-average or impaired insurance risk and is charged a higher than standard premium
Term
Skilled nursing care
Definition
Medical care leading to recovery which is received on a daily basis
Term
Scheduled benefit
Definition
List of cash allowances payable for various types of benefits which does not imbrues the insured for actual expenses but pays what is listed
Term
Limited policies
Definition
Restrict benefits to specified accidents or diseases, such as travel policies, dread disease (cancer) policies, and so forth
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