Basics 101
Pre-Existing
CA Variations
Limited Disability Benefits
Coverage Verification
100
If you are eligible for insurance, you may enroll for such insurance by completing this.
What is the enrollment form?
100
The 3 represents this in a 3/12 pre-ex provision.
What is the look back period?
100
In California, the term own occupation is replaced by _______.
What is Usual Occupation?
100
M&N is an abbreviation for _____________.
What is Mental and Nervous?
100
This state should be listed in the coverage verification.
What is Situs State?
200
To find if claimant is in an eligible class, you must first review this
What is a contract?
200
The middle 3 represents this time period in a 3/3/12 pre-ex provision.
What is the treatment free period?
200
In California, disability or disabled means that as a result of Sickness or injury You are either _______ Disabled or ______ Disabled.
What is Totally and Partially?
200
The LDB duration,___________, stipulates that benefits are limited to only one period of disability during the claimant's lifetime while covered under that particular plan. It is most often seen with the alcohol, drug or substance abuse or addition limitation.
What is One Occurrence per Lifetime?
200
If there is a gap between ________ and ________, this should be noted in the coverage verification.
What is Date Last Worked and Date of Disability?
300
Most contracts indicate this minimum # of hours must be worked/week for eligibility
What is 20?
300
To determine if claimant was treated in the look back period, you will need to obtain and review these
What are medical records?
300
This type of Workers' Compensation will not be an offset in California.
What is permanent workers' compensation?
300
The LDB duration,____________, states benefits are payable per occurrence Condition Limit Date if the claimant is confined as an in-patient in an institution or facility on the Condition Limit Date. These benefits are normally paid through the discharge date from the facility.
What is Per Occurrence with Confinement?
300
In coverage verification, it should be stated if the claimant was actively at work on the day before _____________.
What is Date of Disability?
400
If your Employer pays for your coverage 100%, your plan is this
What is non-contributory?
400
The last number in the two or three tiered option represents this
What is the length of time the pre-ex applies?
400
______ is defined as the claimant's ability to sustain the physical and/or cognitive demands of their occupation on a regular basis and/or on a regular schedule and to meet the expected requirements of the occupation.
What is Reasonable Continuity?
400
This measurement can include all, or part, of the LTD elimination period when the limited disability benefit condition commenced prior to the LTD benefit start date.
What is period of disability?
400
In coverage verification, it should be reported if the claimant has the core plan or a ______.
What is a Buy Up?
500
If I am one of these two types of employees, I am generally not eligible for coverage
What is temporary or seasonal?
500
To determine if a pre-ex investigation is needed, these two initial dates are needed
What is Insurance Effective Date(IED) and Date Disability Commenced(DDC)?
500
These type of tiered pre-ex provisions are not allowed in California.
What are 3 or more tiers?
500
These four types of medical conditions may be limited
What are Mental and Nervous Disorders(M&N), Neuromuscular, musculoskeletal or soft tissue disorders(NMS), Chronic fatigue syndrome and related conditions(CF) and Alcohol, Drug or Substance Abuse or Dependency(A&D)?
500
These four things should be taken into consideration when it is determined the claimant has purchased the buy up.
What is buy up benefit percentage, buy up effective date, evidence of insurability needed for buy up and pre-existing condition review needed for buy up?
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