Learn about respite care in health insurance. Understand how temporary care allows family caregivers to take a break while the patient receives professional care.
Discover how Continuing Care Retirement Communities offer residents seamless access to health care services, promoting healthier living in retirement.
Learn what a Skilled Nursing Facility (SNF) is, and how it provides therapy and nursing care to patients under Medicare.
Understand the Non-disabling Injury Rider in disability income policies, which covers medical costs for injuries that do not result in total disability.
Learn about the role of the Pharmacy and Therapeutics Committee (P&T) in health insurance, how it influences prescription drug use, and its importance to health plans.
Learn about the enrolling unit in health insurance and its critical role in managing group health plan memberships. Discover how a company or group becomes an enrolling unit and the implications for members.
Discover the essentials of hospital affiliation in health insurance, including how agreements between hospitals and health plans affect the care received by members.
Learn about over-the-counter (OTC) drugs, their definition, and their relevance in general insurance. Find out how OTC drugs impact your insurance policy.
Discover the importance of the Place of Service in health insurance, including common locations like hospitals and physicians' offices. Understand how it impacts your coverage and reimbursement.
Learn about the proration of benefits in health insurance, an adjustment made to medical benefits due to duplicate coverage from another policy.
Learn about the terminally ill status in health insurance, including its definition and implications for policyholders and beneficiaries.
Learn about the Utilization and Review Committee in healthcare insurance, which monitors services and supplies provided to Medicare patients to ensure compliance and quality.
Learn about Flexible Spending Accounts (FSAs) in health insurance, pre-tax deductions, and coverage for child care or medical expenses. Understand the benefits and limitations, including the forfeiture rule at year's end.
Learn about utilization review in health insurance, a crucial process for controlling medical costs by monitoring the quality, necessity, and appropriateness of healthcare services. Understand how employers and insurance companies utilize this process to ensure optimal care.
Learn the purpose and function of a surgi-center, a facility providing surgical services on an outpatient basis. Find out how it fits within the health insurance landscape.
Learn about the calendar year deductible in health insurance—how it works and its importance no matter how many claims are made within a calendar year.
Learn what a Superbill is in health insurance. It lists every service provided by a doctor, aiding in accurate billing and claims.
Discover how hospital alliances work in health insurance, enabling multiple hospitals to share services and reduce costs, helping them stay competitive in the healthcare market.
Learn about the Health Care Financing Administration, a division in the Department of Health and Human Services that oversees Medicare and Medicaid and sets certification guidelines for medical care providers.
Discover the definition of a health insurance enrollee and why they do not include dependents. Learn what it means to be an enrollee in a health insurance context.
Explore the crucial role of a Registered Nurse (Health Insurance) in providing nursing care, including medication distribution, and their importance in the healthcare system.
Learn about Retrospective Rate Derivation in Health Insurance, where employers pay a fraction of health care costs and may receive refunds based on actual expenses.
Learn about the Fee for Service (FFS) reimbursement model in health insurance, where health care professionals are paid based on individual services provided.
Discover the essentials of Hospital Indemnity Insurance, a type of health coverage that provides regular payments during hospital stays, irrespective of actual costs. Learn how it works, its benefits, and key considerations.
Learn about Medical Savings Accounts (MSAs) in health insurance, which are funded by employer contributions. Discover how employees can use these accounts for medical expenses and potential cash withdrawals.
Learn about providers in health insurance, including doctors, nurses, and groups who offer medical care and services.
Explore what service benefits in health insurance mean, how they differ from traditional insurance plans, and the advantages they offer based on days of coverage.
Learn about Social Security Tax in Health Insurance, including how it functions, who pays it, and its role in funding social security programs.
Discover how the Prospective Payment System (PPS) operates in health insurance, particularly with Part A Medicare, and how reimbursement is determined based on patient condition at hospital admission.
Explore the essential details about intermediate care in health insurance, including its definition, benefits, and how it differs from skilled nursing care.
Explore the concept of recidivism in health insurance, focusing on the frequency with which insured individuals are readmitted to the hospital for inpatient treatment due to the same ailment.
Learn about the Staff Model HMO, a type of Health Maintenance Organization (HMO) where premiums are paid directly to the HMO, which employs physicians who receive salaries and predetermined bonuses.
Learn about the time limit on certain defenses in health insurance, a mandatory provision that limits the insurer's ability to deny claims based on pre-existing conditions. Understand its legal implications and coverage details.
Explore the Hospice care services covered by Medicare Part A, including pain and symptom relief for patients with terminal diseases and support for their families.
Learn about the Point of Service Plan (POS) in health insurance, where patients have the flexibility to choose between participating and non-participating providers.
Learn about Alternative Dispute Resolution (ADR) mechanisms in health insurance, including PPOs and HMOs, designed to offer alternatives to the traditional fee-for-service model.
Understand the importance of Credit Health Insurance, a group insurance covering creditors in case of debtors' total disability. Learn how this form of disability income insurance works.
Learn how the Disability Insurance Training Council Inc., a branch of the National Association of Health Underwriters, supports education and administers university and executive seminars.
Learn what an Intermediate Care Facility is within the health insurance domain. Discover its role in caring for patients who need nursing care but do not require hospital-level attention or skilled nursing facility services.
Explore the Network Model HMO in health insurance, a model that contracts with multiple physician groups allowing broader healthcare access. Learn how this model works and its benefits.
Learn about Qualified Medicare Beneficiary (QMB), who qualifies for Medicare benefits due to income being under the federal poverty guidelines.
Discover how Diagnosis Related Groups (DRGs) are used to determine compensation for medical providers in the health insurance industry.
A comprehensive guide to recipients in health insurance, focusing on eligibility criteria and benefits under the Medicaid program.
Explore the fundamentals of major medical insurance, a health insurance policy with a high deductible that covers most medical expenses. Learn about its coverage limits, participation clauses, and benefits.
Learn who qualifies as a Medicare beneficiary according to the Social Security Administration and what it means to be eligible for Medicare benefits.
Learn about Relative Value Unit (RVU) - a vital metric used in health insurance to determine surgical costs and values through multiplication with a conversion factor.
Explore the concept of total disability in health insurance, a condition that prevents the insured from working in any capacity due to injury or medical condition. Learn how it varies across policies.
Explore the concept of utilization in health insurance, defined as the amount of use a health plan receives from a specific group of policyholders. Learn how it's measured and its impact on policy costs.
Learn about utilization management in health insurance, a vital method for assessing the need for various medical services to ensure appropriate care and cost management.
Learn about the emergency accident benefit in health insurance. Explore how this group medical policy feature compensates policyholders seeking emergency medical attention for accidents.
Explore the concept of allocated benefits in health insurance, including specific payments for supplies, drugs, or X-rays. Learn how these targeted benefits work to provide specialized financial assistance.
Learn about the significance of referrals in health insurance, where a primary care physician recommends an insured individual to visit a specialist.
