Chapter 13 Flashcards
COBRA
A provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 that requires group health plans to allow employees and certain beneficiaries to extend their current health insurance coverage at group rates for up to 36 months following a qualifying event that results in the loss of coverage
Qualified Beneficiary
Any employee, spouse, or dependent child who, on the day before a qualifying COBRA event, was covered under the employer’s group health plan
Qualifying Event
In life insurance, a condition or event that triggers the payment of accelerated benefits, such as an illness that is expected to reduce the insured’s life expectancy to 24 months or less under COBRA, one of the following events that results in loss coverage by a qualified beneficiary: employee’s death or termination, reduction or hours making employee ineligible for coverage; legal separation of employee and eligible dependent or spouse; eligibility for Medicare; or child’s ceasing to be a dependent.
Extension of Benefits
A provision in a medical expense plan under which benefits are extended for any covered employee or dependent who is totally disabled at the time coverage would otherwise terminate. The disability must have resulted from an injury or illness that occurred while the person was covered under the group contract. The length of the extension generally ranges from 3 to 12 months.
Medigap Insurance
An individual or employer-provided medical expense plan for persons aged 65 or older under which benefits are provided for certain specific expenses not covered under Medicare. These can include a portion of expenses not paid by Medicare because of deductibles, coinsurance, or copayments, and certain expenses excluded by Medicare. In individual insurance, also referred to as a Medigap Policy.
Hospital Indemnity Insurance
A medical expense policy that pays a fixed dollar amount for each day a person is hospitalized, regardless of other insurance.
Specified Disease Insurance
A type of medical expense coverage that provides benefits for persons who have certain specified diseases or medical events, such as cancer or heart attacks. The policy may pay for actual medical expenses or, more likely, pay a specified dollar amount, regardless of actual medical expenses and without regard to other coverages.
Critical Illness Insurance
A form of supplemental medical expense insurance that provides a substantial one-time lump-sum cash benefit for listed critical illnesses.
Medicare SELECT Policy
A medigap policy that pays benefits for non emergency services only if care is received from network providers
Temporary Medical Insurance
Short-Term Medical Insurance that generally provides coverage for periods between 30 days and 1 year while a person is between medical expense plans
International Travel Medical Insurance
Interim Medical Insurance for international travelers. It is usually folded into a broader policy to cover many non-health-related travel contingencies.
Hospital-Surgical Policy
An individual Medical Expense policy that provides limited coverage for hospital, surgical, and certain other medical expenses. It is less comprehensive than a major medical policy.
Health Savings Account (HSA)
A savings account for use with a high-deductible medical expense plan and from which certain unreimbursed medical expenses can be paid. Successors to and more attractive than Archer MSAs.
Archer MSA
A type or personal savings account from which unreimbursed medical expenses can be paid. It can be used for employees of small employers or the self-employed and is established in conjunction with a high-deductible health plan. New Archer MSAs can no longer be established.
