Benefits 101

4. : Dental services subcategory that provides coverage for fillings, cleaning, and other routine procedures.
6. : What the plan sponsor pays to the insurance carrier in exchange for coverage.
7. : The amount you are required to pay annually before reimbursement by your health care benefits plan begins.
9. : created after a claim payment has been processed by your health care plan. It explains the actions taken on a claim such as the amount that will be paid, the benefit available, discounts, reasons for denying payment and the claims appeal process. (Hint: this word is an acronym)
10. PERIOD : Related to disability insurance, this is the duration an employee needs to be considered totally disabled for before benefits become payable.
12. : Type of insurance the provides a lump sum benefit payment if you pass away.
15. : The person(s) the life insurance benefit is payable to if designated by the employee.
16. MAXIMUM : The maximum amount of insurance an employee can receive without providing medical evidence. (Hint: first word is hyphenated)
19. PERIOD: The duration an employee needs to be continuously actively employed for before benefit coverage becomes effective.
20. : The ability to convert coverage into a personal policy without providing medical evidence after an employee leaves the group plan.

1. : In insurance terms, means taking on the same level of benefits as an employee had with a previous carrier, so the employee does not lose benefits.
2. : A percentage of a covered service that you are responsible for paying or the percentage paid by your plan. Normally after the deductible is met.
3. : An eligible person, other than the member (generally a spouse or child), who has health care benefits under the member's policy
5. & CUSTOMARY : The maximum amount an insurance carrier will reimburse for service or supply based on their internal evaluation. (Hint: Answer includes “&” symbol)
8. : The concept that only those that are in poor health will enroll in benefits, while those that are ‘healthy’ or without health concerns will not choose to have coverage.
11. : Dental services subcategory that provides coverage for dentures, bridges, and crowns.
13. : Type of insurance that provides a benefit payment if you are unable to work due to sickness or injury (can be weekly or monthly).
14. ILLNESS: Type of insurance that provides a lump sum benefit payment in the event an employee is diagnosed with a life-threatening illness or injury.
17. : Dental services subcategory that provides coverage for braces (more commonly for children under 19).
18. : Type of benefit plan where employees are required to be enrolled the moment they are eligible.