Got Coverage?
A waiting period after a loss and before benefits are paid
What is the elimination period?
A provider that does not accept assignment and is legally permitted to charge an amount higher than the Medicaid approved amount
What is a non-participating provider?
A 50% payout of the benefit of an AD&D policy; a percentage of the benefit payout
What is Capital Sum?
The amount of quarters or years of SS pay in must you have to qualify for SSDI benefits?
40 quarters or 10 years
Employers with more than 20 employees must offer this continuation of health insurance coverage up to 18 months
What is COBRA?
A specified period of time before coverage goes into effect.
What is a probationary period?
The full face value of an AD&D policy
What is Principle Sum?
When a person cannot perform 1 or more of their regular duties but they are not totally disabled
What is Partial Disability?
Allows an employee to convert the group coverage to an individual plan upon termination of eligibility or termination of group plan
What is Conversion Priveledge?
A period of 10 days or 30 days for senior plans that the insured may review the plan and return for a full refund
What is Free Look?
Policy is guaranteed to renew without proof of insurability; Insurer cannot cancel this policy; Premiums are not guaranteed and may only be changed on a class basis not individual basis
What is guaranteed renewable?
A Medicare Advantage Plan that substitutes A & B into a managed care plan; offered by private insurance providers
Medicare part C
An open enrollment period from Jan 1st to Mar 31 for those who did not enroll in part B when eligible; Coverage begins July 1st
What is the General Enrollment Period?
With Medicare part A after there is an inpatient hospitalization and 60 days consecutive out of the hospital what will be required?
What is a new benefit period with a new deductible?
A rating based on a particular geographic region of all insureds in a group
What is a community rating?
This is found on the first page of the policy and identifies the named insured, insurer and the amount of coverage
What is the insuring clause?
Policy that business owners can get; covers employee wages, taxes, utilities, rent, raw materials; will not cover owners income
What is a business overhead expense policy?
The difference between the approved amount from Medicare and the actual charge; it is also the responsibility of the patient
What is excess charge?
A policy classification that covers a disability due to a work injury
What is occupational?
In group insurance this is given to the group sponsor; employees receive certificate of insurance and explanation of benefits
What is Master Policy?
This is LTC coverage that provides relief to a caregiver who may need a break
What is respite care?
How many emergency days are available for non renewable lifetime reserve?
What is 60?
A person over 65 who was covered under employer group plan but is no longer covered; An 8 month period they are able to enroll in this policy
What is a Special Enrollment period?
A rider that will provide "paid up" coverage if the insured cancels or lapses policy due to non payment
What is Nonforfeiture?
Designed to provide coverage for necessary diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care other than acute care in a hospital
What is LTC (Long Term Care)?