Term
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Definition
| _________________ policies provide benefits for the cost of medical care that results from accidents and sickness. |
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Term
| hospital;surgical;medical;first dollar;no deductable;low dollar |
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Definition
| Base plans cover three basics _______________, ______________, and ______________. They feature ____________, ______________,and _______________ coverage limits. |
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Term
| room & board; miscellaneous |
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Definition
| Basic Hospital policies cover hospital ________________ |
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Term
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Definition
| __________________ policies are designed to pay for the non-surgical doctors services. |
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Term
| Basic Surgical Expense;surgical schedule;relative value |
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Definition
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Term
| medical;supplement major medical; comprehensive major medical |
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Definition
| Policies that provide a broad range of catastrophic medical expense protection under one plan are known as major _________________________ expense policies. The two types available are: _____________________, and _________________. |
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Term
| deductable;coinsurance; large benefit maximums |
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Definition
| In order to prevent over-utilization of the policy, Major Medical plans make use of ___________________ |
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Term
| base plan;corridor;coinsurance |
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Definition
| In a Supplementary Major Medical policy the ____________________ pays first, followed by a ____________________ deductible, then the ____________________ feature. |
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Term
| first dollar; % of incurred cost |
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Definition
| A Comprehensive Major Medical policy without a deductible will pay ___________________ coverage for basic medical benefits after which the insured will pay a __________________. |
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Term
| service providers;prepaid;subscribers |
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Definition
| Health Maintenance Organizations (HMO's) are known as _________________________ as they provide medical services on a ~ 10 basis. Insured's are called _______________________ |
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Term
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Definition
| An HMO that contracts with an independent medical group to provide services and pays the group on a _______________ fee basis is called a _____________________. |
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Term
| staff model;salaried employees |
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Definition
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Term
| independent practice association |
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Definition
| With an __________________ the HMO contracts with a combination of independent physicians, medical groups and associations, and the doctors are paid on a fee-for-service basis. |
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Term
| preventative care;primary care physician;gatekeeper |
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Definition
| HMOs' stress __________________________. At enrollment, the insured selects a ______________________ (also referred to as a __________________________ to oversee and coordinate referrals. |
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Term
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Definition
| In a ________________ the HMO has an exclusive arrangement with the doctors or hospitals to provide services only to its members. In an ____________________ the doctors and hospitals reserve the right to treat patients not with the HMO. |
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Term
| no choice of doctor; full coverage |
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Definition
| A major drawback to HMOs is that the insured has ______________________ and must see a plan doctor or utilize their facilities to have ______________________________. |
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Term
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Definition
| ______________________ encourage the insured to utilize approved member doctors and hospitals. |
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Term
| fee for service;full coverage;reduced |
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Definition
| PPOs differ from HMOs in two ways. First, they provide services on a negotiated __________________________ basis. Second, the insured must utilize a plan doctor or facility to have ____________________ or their benefits will be _______________________. |
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Term
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Definition
| ________________________ refers to any program designed to contain costs by controlling the behavior of the participants in the plan. ___________ and ___________ are excellent examples of this type of plan. |
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Term
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Definition
| A ___________________________ is comprised of a number of individual or small groups of individuals who do not qualify for group insurance so they band together to purchase insurance. |
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Term
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Definition
| A _____________________________ is a group of employers who pool their risk in order to self-insure. |
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Term
| Blue Cross;Blue Shield;Service Plans;Hospital / Physician;Subscribers |
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Definition
| ____________________ and ___________________ are similar to HMOs in several ways. They are considered _________________, because benefits are paid to the ____________________ not the ___________________. |
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Term
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Definition
| Blue Cross provides benefits for __________________ expenses; Blue Shield provides benefits for _________________ expenses. |
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Term
| Disability Income Policies |
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Definition
| ________________________ are intended to replace your income if you become totally disabled and unable to perform work duties for a period of time. |
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Term
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Definition
| The ________________________ definition for total disability requires you to be unable to perform any occupation for which you are reasonably suited by reason of education, training or experience. |
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Term
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Definition
| The __________________________ is the more liberal definition of total disability. |
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Term
| presumptive disability;any 2 limbs;speech;sight in both eyes |
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Definition
| _____________________________ specifies the conditions that will automatically qualify you for full disability benefits. They are the loss of __________________, __________________, or ____________________, and __________________________________________ (total and permanent). |
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Term
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Definition
| When an insured goes back to work after total disability and suffers a relapse within a specified time period, the ______________________ provision states that it will not be counted as a new period of disability and there will be no new _______________________period. |
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Term
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Definition
| The period of time you go without benefits at the onset of a disability is your ________________________ |
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Term
| probationary period;illness |
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Definition
| The period of time you are not eligible for benefits after the issuance of a disability policy is the __________________________________ This usually only applies to ____________________-related disabilities. |
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Term
| accidental bodily injury;accidental means |
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Definition
| Injury in Disability Income policies would be defined using either the _____________________________ or the ________________________ definition. |
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Term
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Definition
| __________________in a Disability Income Policy would be defined as either an illness or disease contracted after the policy has been in force for at least 30 days. |
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Term
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Definition
| Insurance companies will not reimburse 100% of lost income to prevent __________________________ |
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Term
| social insurance supplement (SIS) |
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Definition
| ______________________ riders supplement or replace benefits that might be payable under Social Security Disability. Generally, they pay what Social Security will not. |
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Term
| Business Overhead Expense (BOE);salary |
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Definition
| A _____________________ policy is designed to cover various business expenses associated with operating a business when the owner is on disability. These policies will not cover the business owner's ____________________. |
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Term
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Definition
| A ____________________ disability income policy provides a benefit to the employer if a covered employee becomes disabled. |
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Term
| disability buyoff agreement;elimination period;totally;permanently |
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Definition
| A ________________________________________________ specifies who will purchase a disabled partner's interest in the company if totally disabled. These policies generally have a one or two-year ___________________________ to make sure the partner is _________________________ and __________________ disabled. |
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Term
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Definition
| Individual Disability policies usually specify a ________________________ benefit payable; group policies usually pay a __________________ of the worker's income. |
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Term
| 6 months;2 years;13 weeks;26 weeks;50%;100% |
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Definition
| Individual short-term disability periods usually have maximum benefit periods of _________ to _________; group plans are generally ________________ to ______________ with benefits of __________________ to ________________ of the worker's income. |
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Term
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Definition
| Group long-term plans provide maximum benefit periods of more than _______________ with monthly benefits usually limited to _________ of income. |
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Term
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Definition
| Group plans usually require that the employee must have worked ____________ to ________________ days before they become eligible for benefits. |
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Term
| limited risk policy;special risk policy |
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Definition
| Two special AD&D policies that pay benefits under specific circumstances are the ___________________ and ______________________________. |
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Term
| LTC - long term care;12 consecutive |
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Definition
| _________________________________ insurance must provide coverage for at least _______________ months in a setting other than the acute care unit of a hospital. |
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Term
| ADL - activities of daily living |
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Definition
| Perils for LTC policies are _________________________. |
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Term
| skill nursing care;intermediate care;home health care |
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Definition
| LTC policies will cover three levels of care: ___________________, ____________________, and _____________________. |
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Term
| 30 or more days;2 years to 5 years;50 to 200 dollars |
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Definition
| LTC policies have an elimination period and benefit period that is usually _______________________________, and benefit periods are usually ________________________ with a benefit amount payable of _________________ per day. |
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Term
| 30 days;guaranteed renewable |
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Definition
| LTC policies have a free look period of __________________, and the minimum level of renewability must be ____________________. |
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Term
| association;100;2 years;constitution;bylaws;annually |
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Definition
| _____________________ groups must have ________ members, be organized for a reason other that buying insurance, been active for ______________________, have a _____________________ and __________________, and hold meetings ______________________ in order to purchase insurance for their members. |
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Term
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Definition
| Terminated employees may convert their group policy to an individual policy ____________________ of insurability. They have _________________ from date of termination to exercise this option. |
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Term
| cobra;20;termination;misconduct;divorce;separation |
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Definition
| ________________ requires any employer with _______or more employees to extend group health coverage to |
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Term
| 18 months;36 months;29 months;60 days |
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Definition
| Coverage under COBRA is extended for _________________ due to termination of employment______________for death and divorce or separation, and _____________________________ if on Social Security Disability. Terminated employees have ____________________ to exercise this option. |
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