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