Health and medical exam part 2

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Across
  1. 3. range from $100 to $2500. the higher the deductible the lower the premium will be.
  2. 5. may be added to disability policy that would provide a death benefit as well as disability income coverage.
  3. 10. used in disability policies and states that when an insureds total disability income exceeds their earned income amount, the benefits will be reduced on a pro-rated basis and the excess paid premiums will be proportionally refunded. -the benefit limit is based on their average earnings over the last 24 months.
  4. 11. Health plan with lower premiums and a higher deductible for major care such as hospitalization or surgery.
  5. 14. if a nonmember physician provides service under a Point of Service plan, then the service provider will be paid a fee for their service. However, the member will be required to pay a higher co-insurance amount.
  6. 19. Is provided inpatient Hospital care, in or out of their service are for at least 90 days per year. Treatment for a disorder or for drug and alcohol rehabilitation is 30 days per year.
  7. 22. -employee must be employed 30-90 days-benefits are generally a percentage of the workers salary -short term policies for groups are often 13-26 weeks and pay 50-100% of their income-In some circumstances plans are limited to non-occupational disabilities
  8. 24. designed to fill in gaps left by a variety of government benefit programs. these programs pay the approximate amount of benefits that would be received from the government benefits programs however if the government benefit program does pay the benefits are reduce dollar for dollar. provided in 3 situations 1. an individual may be eligible before benefits begin2. an individual was denied coverage 3. the ss benefits payable may be less than the amount payable under the ss supplement rider
  9. 25. rider allows an insured to increase their disability income benefits at predetermined times specified in policy, without evidence of insurability.
  10. 26. states the coverage will go into effect either on the date of the application, or the date of the medical exam (whichever occurs last) UNLESS the coverage is declined by underwriting. The receipt is intended to provide coverage on a date EARLIER than the date the policy is issued.
  11. 27. coverage begins only when an application is approved by an insurer, but before the policy is delivered.
Down
  1. 1. A return of premium is offered in the event of the death of an insured or if the policy lapses, an insurer will return a portion of the premiums paid to a beneficiary or to the insured if they are still alive.
  2. 2. Are usually very high and are most often lifetime maximum benefits ($1,000,000 or more are normal benefit amounts)
  3. 4. 4 different types: Group independent practice network staff
  4. 6. contracted with a group of doctors and other medical practitioners to provide services at agreed upon costs that are prepaid (cost containment)
  5. 7. legal process performed by insurance company to recover an amount paid to an insured from a third party who may have caused a loss.
  6. 8. If the plan is contributory 75% of the employees must participate If the plan is non-contributory, 100% of the employees must participate and the employer plays the premium -every member must be offered the same benefits-if the group is compromised of more than 50 people medical infomation cannot be required from them.
  7. 9. "out of pocket expenses" is what an insured pays out of pocket during the year. Once an Insured reaches their max out of pocket expenses, the insurance company provides 100% of the coverage for the rest of the year.
  8. 12. combination policy of basic and major medical coverage. Almost all Medical expenses are covered generally using one deductible per individual or family and a coinsurance amount.
  9. 13. (2 types of features) are designed to provide protection against catastrophic loss and benefits for extended illnesses and injuries. these policies feature deductibles, co-insurance, and blanket coverage. there are 2 types: supplemental and comprehensive
  10. 15. a health plan that reimburses employees for qualified medical expenses. this is completely funded by the employers and there is no limit on the amount an employer can contribute. -tax deductible as business expense.
  11. 16. Longer elimination period (90days-6 months) and longer benefits period (2-5years or to age 65). Lower paid employees are generally limited to 66 2/3% of their net income, and higher paid employees are limited to 50% of their net monthly wage. The maximum benefit is based on the employees monthly income.
  12. 17. must be given to every applicant that provides basic information about the cost and coverage of the insurance being solicited. -Must be given NO LATER than the time the application has been signed.
  13. 18. Usually vary as to the max period for which benefits will be paid, most often 3-5 years, but no less than 24 months (2years). A longer benefit period results in the insured paying a higher premium.
  14. 20. All individuals who have turned 65 can apply within the first 6 months of becoming 65 without any underwriting. after 6 months it will be underwritten, meaning the insurance company will be able to exclude preexisting conditions.
  15. 21. care policies Must provide coverage for at least 12 consecutive months of care in a setting other than an acute unit of a hospital. They must also offer policyholders the option of purchasing coverage that will raise their benefit levels to account for reasonably anticipated increases in costs
  16. 23. (Income replacement contracts) pure loss of income policies replace 70-80% of an insured pure loss of income if an insured suffers from a loss of income due to a covered sickness or accident. -in this type of policy if an insured is still able to perform all of the duties after the accident or sickness they will still get paid.