Health Insurance

Front 1

The gap between the Basic Plan and Major Medical in a Comprehensive Major Medical policy is known as a

Back 1

Corridor deductible

Front 2

The Social Security rider is utilized to

Back 2

1 Eliminate confusion and allow the insured to receive Social Security Benefits
2 Virtually all must contribute

Front 3

The Cost of Living Rider

Back 3

Increases coverage automatically based on the index, but the premium increases

Front 4

Stop-loss limit

Back 4

Many Major Medical policies include a provision whereby when expenses reach a certain dollar amount, the insured no longer shares in the cost of expenses, the insurer pays 100% of remaining covered charges. This is referred to as the:

Front 5

Occupational coverage provides coverage

Back 5

On and off the job

Front 6

Hospital Indemnity policies

Back 6

Hospital Indemnity policies are limited polcies and do not follow the principle of indemnity. The pay in addition to each other.

Front 7

Ｍedicare Supplement

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A The maximum probationary period is 6 months
B The free look is 30 days from the policy delivery
C Applicants may not be rejected or uprated during the 6 month open enrollment period
D Insurers may offer plans that contain only the 'core' benefits

Front 8

HIPPA

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1. To waive the probationary period when switching group coverages
2.health coverage is “portable” from one group to another group without any new probationary period as long as coverage was continuous with no gaps greater than 63 days.

Front 9

coordination of benefits

Back 9

1. To prevent overinsurance, the secondary insurer does not pay
2.On a Group Medical Expense policy, it allows the insured to collect in full while avoiding over insurance

Front 10

Eligibility period

Back 10

The time a new employee must wait before group coverage takes effect is:

Front 11

Medicaid is funded by

Back 11

State and federal moneys

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Medicare part A

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hospital

Front 13

AD&D

Back 13

AD&D is a limited type of Health insurance in that if covers accident only. The policy has two parts: The Principal Sum, which pays a lump sum for accidental death; and the Capital Sum, which pays a lump sum for accidental dismemberment. AD&D policies do not follow the Principle of Indemnity, in that if an insured buys more than one policy, each policy pays in addition to the others. AD&D is not Life insurance.

Front 14

Probationary period

Back 14

The probationary period in a group Health policy applies to people who enroll in the group after the policy’s effective date, such as newly hired employees. In other words, the employer may be concerned that a new employee took the job just to obtain insurance, so they are on ‘probation’ for a period of time before they can enroll in the Group plan

2. Most new Medical Expense policies contain a probationary period that states that there is no
coverage if a pre-existing sickness that the insured was treated for during a specified time prior to the new policy’s effective date reoccurs within a specified
time after the new policy was issued.

3.the probationary period protects the insurer against adverse selection.

Front 15

Medical Information Bureau (MIB)

Back 15

The MIB is a non-profit information agency formed to assist health insurers uncover misrepresentations or fraudulent actions by applicants for insurance. MIB members that find an impairment in underwriting report such findings, as well as situations which applicants have previously been involved in and information received from physicians or other persons commenting on the status of a proposed insured.