Medical Plans
This managed care plan only covers expenses within the network. This is an extreme form of a preferred provider organization.
What are Exclusive Provider Organizations (EPOs)?
This Part of Medicare covers care beyond hospitalization. It is available to those with Part A.
What is Medicare Part B?
This required provision requires you to notify the insurer within 20 days of a loss. Sometimes this is not possible so you must do it as reasonably possible.
This tells the insurer when the insured intends to file a claim.
What is the notice of claims provision?
The federal government sought to reduce the number of uninsured Americans and the cost of medical care with this act.
This board game, where players buy and trade properties, is named after a term for exclusive control over a market.
What is Monopoly?
Basic hospital expense, basic surgical expense, and basic physician expense policies are all this type of policy.
What is a basic medical expense (indemnity) policy?
This provides health care coverage to people whose income, health, or age qualifies them for it.
It's funded by the federal and state governments, but the states administer it. The federal government pays a percentage of expenditures.
What is Medicaid?
This common provision can be found in individual and group health insurance policies.
In an individual policy, this period is the time that needs to pass between the policy's effective date and time when losses are covered. It helps the insurer avoid adverse selection.
What is the probationary period provision?
This is a health insurance feature in which benefits are coordinated among various issuing plans and providers. They are included in every group policy.
What are the coordination of benefits (COB)?
This is the largest desert in the world, covering most of North Africa.
What is the Sahara Desert?
This is a type of major medical insurance. This plan is not combined with other medical expense plans. This is a stand-alone plan.
What is comprehensive major medical?
This type of long term care helps a person with daily living activities like bathing, dressing or eating. While it must be directed and monitored by a licensed physician, it doesn't need to be administered by skilled professionals and is often given by nurse aides.
It can be given in nursing homes, assisted living facilities, adult day care, respite centers, or a home.
What is custodial long term care?
This optional provision applies to disability income insurance policies. It avoids overinsurance by reducing the benefit amount if the disabled insured receives more income from the insurance benefit than from their job.
Any premiums paid for excess coverage are returned to the insured.
What is the relation of earnings to insurance?
This is a reduced benefit paid to insured who have been getting benefits for total disability and are now slowly getting back to work.
Also called a recovery benefit.
What is partial disability?
This former United States president made Thanksgiving, Independence Day, Christmas Day and New Year’s Day federal holidays during his presidency in 1870.
Who is Ulysses S. Grant?
This form of coverage addresses a variety of conditions/medical services. Covers routine doctor visits, hospital expenses, surgical care, medical treatment, and more. The more services covered, the more expensive.
What is comprehensive coverage?
This is a type of Medicare Advantage plan. Medicare pays the private plan for traditional covered services and the plan determines which additional services it will cover and what share of expenses the Medicare beneficiary will pay.
What is a Private Fee for Service plan (PFFS)?
This required provision compels the insurer to pay claims immediately after receiving proof of loss. They will pay benefits for disability claims at least monthly.
What is the time of payment of claims provision?
This covers outstanding business loans when the owner becomes disabled. The owners buys this to cover the term of the loan.
If they become disabled during this term, the policy makes monthly loan payments as they come due. These payments diminish over the policy's term.
What is disability reducing term insurance?
Spell Ashley's last name
Lehnert
This review assesses the need for appropriateness of health care services for members/subscribers. The review can take place before, during, or after a medical services is provided.
The purpose is to restrict a member's use of medical services.
What is a utilization review?
This is a state run program offered in every state that reduces Medicare costs for eligible people.
It helps people with limited income and financial resources pay for Part B premiums, deductibles, and coinsurance.
What are Medical Savings Programs (MSP)?
This required provision limits the time an insurer can void a policy or deny a claim for material misrepresentation on the application. Similar to the incontestability provision in life insurance.
Once a policy is in effect for 2 years, it can't be voided or denied.
What is the time limit on certain defenses provision?
This is a kind of corporation which enables the company to enjoy the benefits of incorporation but be taxed as if it were a partnership.
This is allowed by the IRS for most companies with 75 or fewer shareholder.
What is a S corporation?
Out of the nine wars the US participated in, these two lasted the longest.
What are the Revolutionary War and Vietnam War?