Flashcards
An HMO physician, selected by the member, who controls the member's access to specialists.
What is a Primary Care Physician (PCP)?
Parts A and B together are called this name
What is Original Medicare?
Most DI policies only cover these types of disabilities.
What are Nonoccupational Disabilities?
These plans are systems of healthcare delivery. They share the cost of the service with the managed care provider.
Group short-term disability income plans usually cover only what kind of disabilities?
What is nonoccupational disabilities?
An individual tax-favored savings account used to fund medical costs associated with high-deductible insurance plans
What is an HSA?
Three months before or up to three months after the month the person first becomes eligible for Medicare.
What is the Initial Enrollment Period?
This policy benefits only the business that owns the policy.
What is Key Person Disability Income Policy?
Coverage under medical expense insurance that covers a variety of conditions or medical sevrices.
In a group life policy, this indicates the sponsor as policy owner and premium payor.
What is a Master Policy?
A mandatory health insurance contract provision that requires the insurer, within 15 days of being notified of a loss, to provide to the insured any forms needed to file a claim.
Claims Form Provision
The process by which applicants exhaust their assets to qualify for medicaid, if these assets are above the allowable limits.
What is spending down?
This provision limits the amount of benefits the insurer will pay based on benefits from all insurers and policies the insured owns.
What is relation-to-earnings provision?
A more common method of basing benefit payments on
A trust of two or more employers that buy group insurance for their employees. Contributions from the employers, employees, or a combination of both are paid into the trust.
what are METS?
A type of DI policy that provides surviving business owners with the funds needed to execute a buy-sell agreement upon a co-owner's disability.
What is a Disability Buy-Out Policy?
A renewability provision in a health insurance policy under which the insurer guarantees that, during the guaranteed renewable period, it will not cancel the policy, and it will increase premiums only on a class basis.
What is Guaranteed Renewable?
A provision in a health insurance policy under which the insured can automatically qualify for the policy's full benefit if he or she were to suffer from certain specified conditions. These conditions are severe enough that total disability is presumed.
What is the presumption of disability provision?
A feature common to major medical policies that protects the insured by limiting the out-of-pocket dollar amount he or she must pay.
What is stop loss?
Sold by private insurers and managed care providers, these plans complement Medicare coverage and cost the same as coverage for younger employees.
What are Medical Carve-out Plans?
Federal insurance law, passed in 2010, that requires every American to be covered under a medical insurance plan.
Patient Protection and Affordable Care Act (PPACA)
Many LTC insurance policies base total benefits on this idea, of treating the total benefit amount as a sum of money available to cover all types of long-term care until depletion.
What is the Pool of Money Concept?
The amount of the retirement benefit the worker will receive when he or she reaches full retirement age. It is the basis of benefits payabale to the worker's family and dependents.
What is primary insurance amount (PIA)?
A variation of a traditional DI policy that covers the risk of becoming disabled and being unable to pay off a large loan.
What is Credit Disability Insurance?
What is Conversion Privilege?