Health Insurance And Health Insurance Products

Question 0

Accident and sickness insurance

Answer 0

Insurance against bodily injury, disability or death by accident or accidental means, or expense there of, or against disability or expense resulting from sickness, and the insurance relating there of.

Question 1

Accident

Answer 1

A fortuitous event, unforeseen and unintended

Question 2

Accident insurance

Answer 2

A form of health insurance against loss by bodily injury

Question 3

Accidental bodily injury

Answer 3

Generally, traumatic damage to the body, or external origin, unexpected and by the injured person

Question 4

Accidental means

Answer 4

A definition of injury that is based on the concept of contributory negligence.prohibited as a definition for Medicare supplement and long-term care policies

Question 5

Administrative services only

Answer 5

The services provided by an inch or such as providing claim forms, processing claims, and making payments to healthcare providers

Question 6

Blanket accident and health policy

Answer 6

An accident and health insurance policy that covers all of a class of persons not individually identified

Question 7

Blanket medical expense policy

Answer 7

A policy or provision in a policy that pays all medical costs (including hospitalization, drugs, treatments, etc.) without exclusion of any term or maximum on any item. Includes a maximum aggregate benefit under the policy. Often written with a deductible amount.

Question 8

Blue plan

Answer 8

Generic term for those insurers(usually on a service rather than reimbursement basis) Who are authorized to use the designation Blue Cross or Blue Shield and the insignia of either.

Question 9

Cancelable

Answer 9

A contract of health insurance that the insurer may cancel at any time for no stated reason but with five days notice. Unearned premium’s must be refunded.

Question 10

Comprehensive major medical

Answer 10

A plan of insurance that has a low deductible, high maximum benefits, and a coinsurance feature. It is a combination of basic coverage and major medical coverage which has virtually replaced separate hospital, surgical and medical policies with each having its own deductible requirements.

Question 11

Conditionally renewable

Answer 11

A contract of health insurance that provides that the insured may renew the contract to a stated date or an advanced age, subject to the right of the insurance company to decline renewal only under conditions defined in the contract.

Question 12

Deductible

Answer 12

A provision or clause and an insurance policy that the first given number of dollars or percentage of expense will not be reimbursed.

Question 13

Disability benefit

Answer 13

The benefits payable for disability under a disability income policy or provision

Question 14

Disability income insurance

Answer 14

A form of health insurance that provides periodic payments to replace income, actually or presumptively lost, when the insured is unable to work as a result of sickness or injury.

Question 15

Double indemnity

Answer 15

Payment of twice the basic benefit event of loss resulting from specified causes or under specified circumstances.

Question 16

Doughnut hole

Answer 16

The phase in which Medicare seniors must pay 100% of their prescription drug costs until they reach out-of-pocket expenses totaling a stipulated amount. The stipulated amount changes annually.

Question 17

Dread disease policy

Answer 17

A policy, usually offering blanket coverage up to a very high maximum for certain specified diseases only, such as scarlet fever smallpox, polio, tetanus, etc.

Question 18

Elimination Period

Answer 18

A loosely used term sometimes designating the waiting period And sometimes the probationary period

Question 19

Group contract

Answer 19

A contract of insurance made with an employee or other entity that covers a group of persons identified by reference to their relationship to the entity buying the contract. The group contractual arrangement is generally used to cover employees of a common employer, members of a trade association or trusteeship, members of a welfare Association or employee benefit Association, members of a labor union, or members of a professional or other association not formed only for the purpose of obtaining insurance.

Question 20

Health insurance

Answer 20

Insurance against loss by sickness or bodily injury. The generic form for those forms of insurance that provide lump sum or periodic payments in the event of loss occasioned by bodily injury, sickness or disease, and medical expense. The term health insurance is now used to replace such terms as accident insurance, sickness insurance, medical expense insurance, accidental death and dismemberment insurance. The form is sometimes called accident and health, accident and sickness, accident, or disability income insurance.

Question 21

Health maintenance organization (HMO)

Answer 21

And organization of health providers. Each member pays a premium for which he receives medical care when desired. The emphasis is on preventative medicine, and it is an alternative to employee benefit plans. Employers of more than 25 persons are required to offer the alternative of HMO to employees, but not if the cost exceeds that of present employee benefit plans.

Question 22

Hospital benefits

Answer 22

Benefits payable when an insured is hospitalized.

Question 23

Hospital indemnity or income policy

Answer 23

A policy paying a specific Dollar amount directly to the insured for every day hospitalized, usually beginning with the first day and payable for up to one year.

Question 24

Hospital/surgical expense policy

Answer 24

A policy combining benefits of hospital and surgical coverages.

Question 25

Hospitalization expense policy

Answer 25

A policy which covers daily hospital room and board charges and also covers miscellaneous hospital expenses such as x-rays. It also covers emergency treatment charges and many times will also include a surgical benefit.

Question 26

Hospitalization policy

Answer 26

A policy that reimburses the policy owner for certain specified costs of hospital confinement.

Question 27

Non-confining sickness

Answer 27

A sickness or disability that is not confined the insured indoors

Question 28

Noncontributory

Answer 28

Any plan or program of insurance (usually group) for which the employer pays the entire premium and the employee contributes no part of the premium

Question 29

Non-occupational policy

Answer 29

A policy or provision of a policy which excludes accidents occurring on the job, when such employment is covered by Worker’s Compensation.

Question 30

Occupational accident

Answer 30

An accident occurring in the course of one’s employment and caused by hazards inherit or related thereto.

Question 31

Occupational disease

Answer 31

Impairment of health caused by continued exposure to conditions inherent in a person’s occupation or a disease caused by unemployment or resulting from the nature of an employment

Question 32

Occupational Hazard

Answer 32

A condition in an occupation that increases the peril of accident, sickness, or death there from.

Question 33

Optionally renewable

Answer 33

A contract of health insurance in which the insured reserve the understood the right to terminate the coverage at any anniversary or, in some cases, at any premium due date, but does not have the right to terminate coverage between such dates.

Question 34

Outpatient

Answer 34

A patient who is not a bed patient in the hospital in which he receives treatment.

Question 35

Over insurance

Answer 35

A condition in which 1. More insurance is in force on the insured or the risk than the potential loss or 2. So much is in force as to constitute a moral or morale hazard (such as so much disability insurance being in force that it becomes profitable to become disabled.)

Question 36

Partial disability

Answer 36

A condition in which, as a result of injury or sickness, the insured cannot perform all of the duties of his occupation but can’t perform some. Exact definitions ferry from policy to policy.

Question 37

Permanent and total disability

Answer 37

Total disability from which the insured does not recover. When used as a definition and a policy (usually a life insurance policy rider), “permanent” is presumed after a stated period of time, commonly six months.

Question 38

Preferred provider organization (PPO)

Answer 38

And organization of hospitals and physicians who provide, for a set fee, services to insurance company clients. These providers are listed as preferred and the insured may select from any number hospitals and physicians without being limited as with an HMO. Coverage is 100%, with a minimal copayment for each office visit or hospital stay. Contrast with health maintenance organization.

Question 39

Prepaid hospital service plan

Answer 39

The common name for health maintenance organization plant (HMO). It provides comprehensive healthcare, usually by salaried personnel, for members who pay a flat fee for the services, whether outpatient or hospital treatment is needed.

Question 40

Probationary period

Answer 40

A period of time between the effective date of the health insurance policy and the day coverage begins for certain conditions.

Question 41

Reoccurring clause

Answer 41

A health insurance policy provision defining the duration of a period of time during which the recurrence of a condition will be considered a continuation of a prior period of disability or confinement.

Question 42

Relative value schedule RVS

Answer 42

Shows the value of one medical procedure in relation to another.

Question 43

Residual disability

Answer 43

That form of disability which becomes defined as partial disability when and insured has returned to work immediately following a period of total disability.

Question 44

Salary savings plan

Answer 44

Insurance issued to individual employees whose employer agrees to deduct the premiums from their paychecks and remit to the insurance company.

Question 45

Self-inflicted injury

Answer 45

And injury to the body of the insured inflicted by himself.

Question 46

Self Insurance

Answer 46

Making financial preparations to me pure risks by appropriating sufficient funds in advance to meet estimated losses, including enough to cover possible losses and access to those estimated. Few organizations are large or dispersed enough to make this a sound alternative to insurance

Question 47

Service plans

Answer 47

Plans of insurance or benefits are the actual service rendered rather than a monetary benefit, such as the benefits provided by Blue Cross and Blue Shield.

Question 48

Short term disability income policy

Answer 48

A disability income policy with benefits payable for short-term, usually less than two years, as opposed to a long-term disability income policy.

Question 49

Sickness insurance

Answer 49

A form of health insurance against loss by illness or disease. This form of health insurance provides benefits and event of loss occasioned by sickness (either illness or disease). Illness or disease does not include accidental bodily injury. Sickness insurance may provide benefits for loss of time for expense incurred by pregnancy.

Question 50

Standard provisions

Answer 50

(1) provisions prescribed by state law that must appear and all policies issued in that jurisdiction. (2) provisions adopted by the NAIC to apply to group life insurance as minimum protection. They are required by law and most states. (3) formally, a set of prescribed provisions regulating the operating conditions of a health insurance policy by law in most jurisdictions between about 1912 and 1950. They are now superseded by uniform provisions for individual accident and health insurance policies which contain and NAIC model bill. These have been enacted in virtually all jurisdictions.

Question 51

Subscriber

Answer 51

The insured, when speaking of prepaid hospital plans.

Question 52

Total disability

Answer 52

A degree of disability from injury or sickness that prevents the insured from performing the duties of any occupation for remuneration or profit. The definition in any given case depends on the wording in a covering policy.

Question 53

Uniform provisions

Answer 53

A set of provisions relating to the operating conditions of a health insurance policy that are specified by state law. Uniform provisions law is the national Association of insurance commissioners model law entitled, “Uniform Individual Accident and Sickness Policy Provisions Law.”