health insurance
a plan for sharing the risk of high medical costs related to injury or illness
group insurance
the most common type of this kind of insurance; all those insured have the same coverage and pay a set premium; often obtained through employers
COBRA
a law that allows people who leave employment to continue their health insurance under the company plan for 18 months
HIPAA
limits the pre-existing conditions that group plans may exclude; it makes it illegal for an insurer to deny coverage based on health status, though it does not limit the amount the insurer may charge
pre-existing conditions
medical conditions or symptoms that were known to the participant or diagnosed within a certain time period before the effective date of the plan
double coverage
a group health insurance provision that specifics how the insurers will share the cost when more than one policy covers a claim
Flex 125 Plan
employee benefit program that allows employees to set aside money, pretax, to help pay deductibles, co-payments, and other health expenses not covered by insurance; however if you don't use it, you lose it
supplemental insurance
a secondary insurance policy used to help pay high deductibles and co-payments
individual insurance policies
health insurance coverage not as part of a group; requires an exam; is usually expensive
basic health insurance
medical, hospital, surgical costs
medical coverage
covers physician care that does not include surgery such as office visits, x-rays, and lab tests
hospital coverage
covers hospital bills for room, board, and medication
surgical coverage
covers surgeon's fees
major medical coverage
protection against catastrophic expenses of a serious injury or illness; usually has a lifetime maximum
stop-loss provision
insurance clause that caps a maximum that the insured has to pay during any calendar year
dental insurance
covers dental exams, cleaning, and dental x-rays, and fillings
vision insurance
covers eye exams
unmanaged care
a plan that allows participants to chose any doctor and to be reimbursed for a portion of the expenses incurred after a deductible is met
managed care
health care plan that relies on a network of health care providers; participants must select doctors who belong to the network; must have pre-approval for surgery
types of managed care plans
HMO
PPO
POS
HMO Health Maintenance Organization
group plan offering medical care to its members; patients must choose doctors on the staff including their primary care physician
primary care physician
main health care provider
examples of preventative care
routine physical exams and vaccinations
preventative care
treatment before a minor ailment becomes a major problem
capitated
per person
PPO Preferred Provider Organization
a group of health care providers who band together to provide health services for set fees; patients can choose doctors from an approved list but can go outside the plan but have to pay a higher fee
POS Point of Service
combination of HMO's and PPO's
Medicare
government-sponsored health insurance for people aged 65 or older; run by social security administration
medicap insurance
a supplemental private insurance policy to pay deductibles and co-payments
Medicaid
government-sponsored health insurance for people with low incomes
high-risk pools
make it possible for people who are otherwise "un-insurable" to obtain some type of coverage
disability insurance
an insurance plan that makes regular payments to replace inocme lost when illness or injury prevents the insured from working
income protection
another name for disability insurance
waiting period
the amount of time one must wait for insurance benefits to begin
duration of benefits
the length of time an insurance company will pay disability insurance
guaranteed renewability
protection against cancellation of an insurance policy
OASDI Old age, survivors, and disability insurance
government-sponsored disability insurance
worker's compensation
a form of insurance paid by the employer providing cash benefits to workers injured or disabled in the course of employment.
life insurance
provides funds to the beneficiaries when the insured dies
mortality tables
statistical tables used to gather life expectancy
group life insurance
insurance plan that insures a large number of people under the terms of a single policy without a medial examination
portability
when you leave your employer, you are able to continue paying the premiums and convert your group into an individual policy
beneficiaries
people named in an insurance policy who will receive the benefits of the policy
incontestable clause
provision of a life insurance policy stating that once the policy has been in effect for a stated period of time, the insurer many no longer question items on the application or deny coverage
life insurance rider
small insurance policy that modifies the coverage of the main policy
waiver of premium
allows one to stop making payments and keep coverage in force if you become disabled
guaranteed insurability
riders that five you the right to renew a policy or buy additional coverage regardless of changes of health
double indemnity
the beneficiary is paid double the face value of the insurance policy
temporary life insurance
a life insurance policy that lasts for a specific period
permanent life insurance
a life insurance policy that lasts for life
term life insurance
life insurance policy that remains in effect for a specific period of time
pure life insurance
another name for term life insurance
decreasing term insurance
the amount of coverage decreases each year while the premium remains the same
level term insurance
the amount of coverage remains constant from beginning to the end
credit life
this insurance can be used only to repay a specific debt should the borrower die before doing so; obtained through a lender
renewable term life insurance
the policy holder has the right to renew each year without passing a physical exam
cash value
the savings accumulated in a permanent life insurance policy that the policy holder receives if their policy is cancelled
whole life
a life insurance policy that you pay fixed premiums throughout your life and the policy pays a stated sum at death
limited-pay life
a life insurance policy that premiums are limited to a specific number of years or until age 65; at that time, you no longer have to pay any more premiums and the insurance company will pay face value of the policy at the time of death
universal life
life insurance which combines the low cost protections of term insurance with a savings component that is invested in a tax deferred account
variable life
life insurance premiums are invested in market securities