Health Insurance Basics

TRICARE (extra, prime, standard)

regionally managed health care program for active duty and retired members of the armed forces, their families and survivors. It is a service benefit and contains no premium. TRICARE is the new title for CHAMPUS program (Civilian Health and Medical Program of the Uniformed Services)

Dependent

someone relying on the insured for support

Coinsurance

An agreement between an insurer and insured in which both parties are expected to pay a certain portion of the potential loss and other expenses.

Copayment

An arrangement in which an insured must pay a specified amount for services "up front" and the provider pays the remainder of the cost.

An underwriter may obtain information on an applicants hobbies, financial status, and habits by ordering an

Inspection report

Which of the following is true regarding health insurance?

It could provide payments for loss of income

Accident-only policies

Limited policies that provide coverage for death, dismemberment, disability or hospital and medical care resulting from an accident; will only pay for losses resulting from accidents

NAIC

National Association of Insurance Commissioners, an organization composed of insurance commissioners from all 50 states, the District of Columbia and the 4 U.S territories, formed to resolve insurance regulatory issues.

Which of the following is the most common time for errors and omissions to occur on the part of an insurer

Policy delivery

Hospital Indemnity

Provides a specific amount on a daily, weekly, or monthly basis while the insured is confined to a hospital; based only on number of days

Dread disease

Provides a variety of benefits for a specific disease such as cancer policy or heart disease policy (fixed dollar amount or scheduled)

Deductible

The portion of the loss that is to be paid by the insured before any claim benefits may be paid by the insurer.

Waiting period

a period of time that must pass after a loss occurs before the insurer start paying policy benefits

Enrollee

a person enrolled in a health insurance plan, an insured (doesn't include dependents of the insured)

Riders

added to the basic insurance policy to add, modify or delete policy provisions

Pre-existing conditions

conditions for which the insured has received diagnosis, advice, care, or treatment during a specific time period prior to the application for health coverage

Routine and preventative maintenance

covered up to an annual maximum without deductible or copayment; dental exam, teeth cleaning, x ray

comprehensive plan

covers all sickness or accidents that are not specifically excluded

blanket policy

covers members of a particular group when they are participating in a particular activity, without naming individual insureds (such as students, passengers, sports teams)

comprehensive coverage

health insurance that provides coverage for most types of medical expenses

Credit Disability

issued only to those in debt to a specific creditor

Limited Health Care

only cover specific accidents or diseases

Routine and major restorative care

treatment of cavities, oral surgery, bridges, dentures

insolvent

unable to meet financial obligations

Individual Health Insurance

underwritten to cover applicant, their spouse and family

accidents bodily injury

unforeseen and unintended injury that resulted from an accident