Chapters 14 15 16 Flashcards Preview

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Flashcards in Chapters 14 15 16 Deck (20):
1

Waiting period

For disability insurance, the initial period of time when a disabled individual is not eligible to receive benefits even though unable to work; for workers compensation, the days that must elapse before workers' compensation weekly benefits become payable. Also, known as elimination period.

2

Catchment area

In the TRICARE program, an area, defined by zip codes, that is approximately 40 miles in radius surrounding each United States military treatment facility.

3

Compromise and release

An agreement arrived at, whether in or out of court, for settling a workers' compensation case after the patient has been declared permanent and stationary.

4

Disability income insurance

A form of health insurance that provides periodic payments to replace income when the insured is unable to work as a result of illness, injury, or disease and not as a result of a work-related accident or condition.

5

Double Indemnity

A feature in some life and disability insurance policies that provides for twice the face amount of the policy be paid if death results to the insured from accidental causes.

6

Lien

A claim on the property of another as security for a debt. In litigation cases, it is a legal promise to satisfy a debt owed by the patient to the physician out of any proceeds received on the cases

7

Non availability statement- NAS

Is a certification from a military hospital stating that it cannot provide the care needed.

8

Primary care manager - PCM

A physician who is responsible for coordinating and managing all of the TRICARE beneficiary's health care unless there is an emergency.

9

Partial (temporary) disability

A disability from an illness or injury that prevents an insured person from performing one or more of the functions of his or her regular job.

10

Exclusions

Provisions written into the insurance contract denying coverage or limiting the scope of coverage.

11

Waiver of premium

A disability insurance policy provision that an employee does not have to pay any premiums while disabled.

12

Total disability

A term that varies in meaning from one disability insurance policy to another. For example, a liberal definition might read: " The insured must be unable to perform the major duties of his or her specific occupation"

13

Residual benefits

A term used in disability income insurance for disability that is not work related. It is the payment of partial benefits when the insured is not totally disabled.

14

Second injury fund

Subsequent injury fund. A special fund that assumes all of part of the liability for benefits provided to a worker because of the combined effect of a work related impairment and a preexisting condition.

15

Sponsor

For the TRICARE program, the service person ( active duty, retired, or deceased) whose relationship makes the patient (dependent) eligible for TRICARE.

16

Sub Rosa films

Videotapes made without the knowledge of the subject; used to investigate suspicious claims in workers' compensation cases.

17

TRICARE Extra

A preferred provider organization (PPO)-type of TRICARE option in which the individual does not have to enroll to pay an annual fee. On a visit-by-visit basis, the individual may seek care from an authorized network provider and receive a discount on services and reduced cost-share (copayment).

18

TRICARE for Life

A health care program that offers additional TRICARE benefits as a supplementary payer to Medicare for uniformed service retirees, their spouses, and survivors age 65 years of age or older.

19

TRICARE Prime

A voluntary health maintenance organization (HMO)- type option for TRICARE beneficiaries.

20

Work hardening

A individualized program therapy using simulated or real job duties to build up strength and improve the workers' endurance so he or she can work up to 8 hours per day. Sometimes work site modifications are instituted to get the employee back to gainful employment.