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 the importance of extra percentage tables in health and life insurance which indicate the additional premiums for specific medical conditions.
Explore the role of diagnosis in health insurance, where diseases are identified through comprehensive testing and medical attention.
Learn about the Enrollment Period in health insurance, a critical time frame for employees to sign up for health care plans. Get the key insights and deadlines to avoid missing out on coverage.
Learn about pre-admission certification, a process determining whether a hospital admission is necessary based on established criteria in health insurance.
Understand the gatekeeper model in health insurance, where the primary care physician acts as a gatekeeper, directing patient care and referrals. Learn how this affects HMO and PPO plans.
Discover what the Paid Claims Loss Ratio in Health Insurance is, how it’s calculated, and its importance. Learn the key components and implications for policyholders and insurers.
Learn what secondary coverage in health insurance is and how it helps cover charges not covered by a primary policy. Discover the benefits and importance of secondary health insurance coverage.
Explore the meaning of office visits in health insurance, focusing on the services provided by physicians in their offices. Understand this essential aspect of health coverage.
Discover the comprehensive retirement program that provides dedicated health insurance benefits to railroad workers. Learn about eligibility, coverage, and more.
Discover the role of miscellaneous benefits in health insurance, exploring how they cover most inpatient medical costs without including surgical expenses or room and board.
Learn what prescription medication means in the context of health insurance, and why it's essential for medications to be prescribed by a doctor.
Learn about referral providers in health insurance, including their role and importance in ensuring specialized care for insured individuals.
Learn about the Utilization and Review Committee in healthcare insurance, which monitors services and supplies provided to Medicare patients to ensure compliance and quality.
Explore the concept of Medical Loss Ratio in Health Insurance, which is calculated as total benefits divided by total premium. Learn its significance in the health insurance industry.
Learn about traumatic injury in the context of general insurance. Discover the implications of an injury inflicted on the insured’s body by an external force.
Discover what a health plan (health insurance) entails, including details on medical service coverage for members. Learn how these plans ensure access to essential healthcare.
Learn about a Home Health Agency, an essential component in health insurance, approved by and contracted to a health plan to provide certain services.
Learn about home health services covered by Medicare Part A, including care provided by licensed agents. Understand the scope of home health care services under Medicare.
Explore Multi-disciplinary Health Insurance and understand how this treatment approach involving multiple specialists from different disciplines ensures comprehensive healthcare coverage.
Explore the benefits of Comprehensive Health Insurance, which provides total coverage for health care-related charges, applicable after deductibles and co-insurance for hospital or physician's office visits.
Explore the concept of discharge planning in health insurance, a critical process that involves creating a tailored treatment plan for patients after their release from inpatient care. Discover its importance and impact on patient outcomes.
Learn about the Dual Choice in Health Insurance, a federal regulation requiring certain employers to offer both an indemnity plan and an HMO. Applicable to employers with 25+ employees, paying minimum wage or more, offering health care coverage, and a federally certified HMO available in the area.
Learn about Exclusive Provider Organization (EPO) health insurance plans. Discover how EPOs operate with primary care doctors and provider referrals.
Learn about free standing emergency medical service centers, also known as urgent care centers, and their importance in providing emergency medical attention in the health insurance landscape.
Discover the essentials of group health insurance, including hospital stays, medical examinations, treatments, and doctors' fees. Learn about mandatory deductibles and coinsurance payments.
Explore the definition, scope, and legal requirements of mandated benefits in health insurance, including both state and federal regulations.
Learn about the Market Assistance Plan (MAP) promoted by the Department of Insurance, designed to help buyers secure difficult-to-find health insurance. Understand its role, benefits, and how it aids in obtaining the necessary coverage.
Learn about Medicare supplement insurance, an essential adjunct that helps cover deductibles and co-payments not covered by Medicare. Explore how it works, what it covers, and how to choose the right plan for you.
Learn about out-of-pocket costs in health insurance, including deductibles and prescription medication expenses. Discover how they impact your healthcare expenses.
Explore the Physicians and Surgeons’ Equipment Form which provides essential coverage for doctors' and dentists' office equipment, supplies, and furnishings.
Explore the intricacies of risk analysis in health insurance, where benefits and premiums are tailored to fit specific groups based on comprehensive analysis.
Explore the essential aspects of stop-loss insurance, a type of reinsurance for health plans or employer-funded plans, designed to safeguard against substantial financial losses.
Explore the flexibility of cafeteria benefit plans in health insurance which allow employees to customize their premiums and benefits.
Explore the process of signing people up for health insurance plans and understand the significance of enrollment numbers in healthcare coverage. Get insights into health insurance enrollment.
Learn about experimental procedures in health insurance, including definitions, considerations, and how they impact your coverage and medical decisions.
Learn about the role of health history in health insurance underwriting, including its importance in determining risk acceptance for healthcare policies.
Discover the concept of Member Month in health insurance, a metric indicating the amount of participants considered members each month. Learn its significance in health insurance policies and regulations.
Discover what nonprofit insurers are in the health insurance domain. Learn how they provide medical expense reimbursement coverage and their regulatory framework.
Learn about nurse fees in health insurance policies, a clause that allows reimbursement for amounts paid to independent nurses. Discover how this impacts your healthcare costs.
Learn about paid claims in health insurance, which are the amounts paid to health care providers under a health plan. Discover how these claims impact policyholders and insurers.
Learn about precertification authorization in general insurance, its importance, and how it helps in managing treatment costs effectively.
Learn about retention in health insurance and reinsurance, including its impact on administrative costs and the amount of insurance retained by the ceding company.
Learn how the benefit formula in health insurance calculates the amount of benefits an insured person is entitled to under an employee benefit plan.
Get a comprehensive overview of the Summary Plan Description (SPD) in health insurance, detailing all available benefits under a specific plan.
Explore the mandated uniform provisions in health insurance, set forth by the National Association of Insurance Commissioners (NAIC), to understand individual medical policy conditions.
Learn about ancillary benefits in health insurance, including coverage for hospital stay charges such as supplies, X-rays, and diagnostic tests. Understand how these benefits can support your healthcare needs.
Discover the specifics of Blue Shield health insurance, which covers medical and surgical costs. Learn how it complements Blue Cross for complete healthcare coverage.
Learn about Dental Plan Organizations (DPO) in health insurance. Understand their role in providing dental care through agreements with providers.
Learn about group health insurance, a policy where many individuals, often employees of a single business, are covered under one contract. Explore the benefits and key features of group health insurance plans.
Learn about hospitalization expense policies in health insurance, providing coverage for inpatient stays, emergency care, surgical costs, and more. Ensure your medical needs are met with adequate coverage.
Learn about malpractice insurance (liability insurance) that protects medical practitioners from claims of malpractice, covering damages and legal defense.
Learn about the open enrollment period in health insurance, during which you can switch plans without needing proof of insurability. Ensure you make informed decisions about your health coverage.
Explore overage insurance, a specialized health coverage designed for individuals over 65, providing crucial health benefits even beyond the usual age limit.
Understand the role of Peer Review Organizations (PROs), where physicians hired by the federal government review services provided to Medicare subscribers by Medicare-approved facilities.
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.
Explore Blue Cross Health Insurance, a hospital expense plan that provides coverage for hospital treatment with specific restrictions. Learn how Blue Cross and Blue Shield operate under the same federation, with Blue Cross covering hospital expenses and Blue Shield covering medical and surgical costs.
Explore the importance of Druggists' Liability Insurance, which protects pharmacists from legal claims related to prescription filling errors and unfulfilled drug deliveries.
Learn about eligibility periods in health insurance, the time frame during which medical costs are reimbursed and when prospective insureds can enroll without proving insurability.
Learn about Group Model HMO, a type of Health Maintenance Organization that negotiates rates with specific provider groups and hospitals to offer medical care to policyholders.
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 long-term care facilities where nursing or custodial care is provided on a long-term basis, typically licensed and regulated by the state.
Explore the essentials of Medical Expense Insurance, a type of health coverage that includes medical, surgical, and hospital expenses. Learn how it protects you financially in times of medical need.
Learn about primary care in health insurance, focusing on medical care provided by a primary physician. Discover its importance and benefits.
Learn about secondary care in health insurance, which involves specialized medical attention typically provided upon referral from a primary care physician.
Learn about the Attending Physician Statement, a crucial document detailing an individual's medical information used in health and life insurance policy underwriting.
Learn how continuation of health insurance allows former employees to maintain their health insurance coverage after leaving a job, and the conditions they must meet.
Learn about the credentialing process in health insurance, which endorses health care providers to participate in or provide care under health care plans.
Learn about expected morbidity in health insurance, which forecasts the anticipated frequency of illness or injury within a specific group, based on mortality tables.
Learn about what a Free Standing Outpatient Surgical Center (FSOSC) is and how it provides outpatient services to surgical patients. Understand the role of these facilities in health insurance coverage.
Discover the essentials of health insurance, including commercial, private noncommercial, and social insurance classifications. Learn how these plans cover or share healthcare expenses.
Learn about the significance of an intermediate report in health insurance and workers' compensation. This key document provides updates on the condition of individuals with ongoing disabilities.
Learn about the physician contingency reserve in health insurance, a fund composed from claim deductions aimed at motivating appropriate healthcare provision.
Learn about Physicians and Surgeons Professional Liability Insurance, covering physicians in malpractice lawsuits and legal actions related to malpractice accusations.
Learn about the role of a Primary Care Physician (PCP) in health insurance, how they provide primary medical care, and when they refer you to specialists.
Explore the concept of corridor deductible in health insurance, including how it functions and its impact on your medical expenses. Learn about hospital and medical cost payments before coinsurance.
Learn about the Date of Service in health insurance, which refers to the specific day a health care practitioner attends to or treats an insured individual.
Learn about the 'Fee Schedule' in health insurance, which outlines the maximum charges for providers operating on a fee-for-service basis.
Explore the mixture of life insurance and long-term care coverage known as living need benefits. Learn how this practice affects the value of the life insurance policy.
Learn about morbidity in health insurance, focusing on the comparative frequency of disease and its impact on policy underwriting and premiums.
Learn about the importance of the Identification Card in Health Insurance. This card is essential for identifying members of a health care plan and must be presented during medical services.
Understand the concept of fee maximum in health insurance, which refers to the maximum fee available to a health care professional for a service provided under a contract.
Learn about the definition of an in-patient, an individual admitted to a hospital or healthcare facility as a patient in residence, in the context of general insurance.
Discover the role of a Third Party Administrator (TPA) in administrating life and health insurance policies for employers. Learn how TPAs facilitate communication between employers and insurers, process claims, and determine eligibility.
Explore the fundamentals of commercial health insurance, which includes both medical costs and disability benefits, along with renewal provisions and specific benefits.
Learn about hospital benefits in health insurance, which cover costs incurred during hospital visits, including room expenses and additional charges.
Learn about the out-of-pocket limit in health insurance, a critical factor that determines the maximum coinsurance you have to pay before your insurer covers all expenses. Find out how it affects your policy and overall costs.
Learn about the term 'Member' used in health insurance and pensions, describing individuals covered under a health plan or qualified employees in a pension plan.
Learn about the significance of referrals in health insurance, where a primary care physician recommends an insured individual to visit a specialist.
