Chapters 14 15 16 Flashcards Preview

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

Waiting period

A

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
Q

Catchment area

A

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
Q

Compromise and release

A

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
Q

Disability income insurance

A

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
Q

Double Indemnity

A

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
Q

Lien

A

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
Q

Non availability statement- NAS

A

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

8
Q

Primary care manager - PCM

A

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

9
Q

Partial (temporary) disability

A

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
Q

Exclusions

A

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

11
Q

Waiver of premium

A

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

12
Q

Total disability

A

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
Q

Residual benefits

A

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
Q

Second injury fund

A

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
Q

Sponsor

A

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

16
Q

Sub Rosa films

A

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

17
Q

TRICARE Extra

A

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
Q

TRICARE for Life

A

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
Q

TRICARE Prime

A

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

20
Q

Work hardening

A

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.