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 what an Explanation of Benefits (EOB) is, how it itemizes health services, the incurred costs, the payments made by your insurer, and your responsibilities.
Learn about the Fee for Service (FFS) reimbursement model in health insurance, where health care professionals are paid based on individual services provided.
Learn about the grace period in health and life insurance policies, including what it means for your coverage and payment schedules.
Learn about the role of health history in health insurance underwriting, including its importance in determining risk acceptance for healthcare policies.
Learn about the Health Services Agreement, an arrangement detailing benefits, enrollment, and eligibility between employers and insurers in health insurance plans.
Learn about the hospital confinement rider in health insurance, an optional feature that waives the elimination period for inpatient hospital admissions.
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 the Individual Practice Association (IPA) model HMO, where medical services are provided by contracted physicians within an HMO network. Understand how it functions and benefits healthcare consumers.
Learn about Loss of Income Insurance, a crucial form of health insurance that provides coverage in case of lost income. Discover how it protects you financially.
Learn about managed health care plans, including how they involve multiple providers sharing financial risks and provisioning medical care services.
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.
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.
Learn about mental health providers in health insurance, including social workers, psychologists, and psychiatrists who meet federal and state requirements to offer mental health care.
Learn about Multiple Employer Trusts (METs) where small employers within the same industry pool together to purchase group insurance at reduced costs or establish self-funded plans.
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.
Explore the concept of Offset Rider in health insurance, including how it reduces benefits by accounting for the insured’s social security benefits.
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 what a Primary Care Network (PCN) is in health insurance, including the role of primary care doctors within a plan.
Learn about providers in health insurance, including doctors, nurses, and groups who offer medical care and services.
Learn about reasonable and customary charges in health insurance, what they mean for your healthcare costs, and how they relate to provider charges and Medicare-approved costs.
Learn about retention in health insurance and reinsurance, including its impact on administrative costs and the amount of insurance retained by the ceding company.
Explore the Return of Premium clause in health insurance. Learn how it can benefit policyholders by returning the premiums paid, minus claims, under specific conditions.
Learn about Section 125 plans in health insurance, a flexible benefit plan that allows pre-tax employee contributions. Discover how these plans can optimize your health benefits.
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 Short Term Disability Insurance, a type of policy that covers disabilities lasting from 13 to 26 weeks. Understand its benefits, coverage details, and how it fits within Health Insurance.
Explore the concept of Small Group Pooling in health insurance, where small businesses combine into one pool to achieve more accurate rates and improved coverage options.
Learn about Social Security Tax in Health Insurance, including how it functions, who pays it, and its role in funding social security programs.
Learn about swap maternity in health insurance. Understand how pregnancy coverage works under a group health plan and what happens if the plan terminates.
Learn about Temporary Total Disability (TTD), a condition where an employee is expected to fully recover from a disability but cannot work during the recovery period. Explore its implications in Health Insurance and Workers Compensation.
Learn how the benefit formula in health insurance calculates the amount of benefits an insured person is entitled to under an employee benefit plan.
Learn about the co-pay provision in health insurance, which defines the portion of a claim paid by the insurer and the insured.
Explore the significance of the incontestable clause in health and life insurance policies. Learn how this stipulation limits the insurer's time to dispute policy information, protecting policyholders from denied claims due to preexisting conditions or health misrepresentations.
Learn what the Medical Information Bureau is and how it impacts health and life insurance. Discover how insurers use this bureau to access coded health condition information on individuals.
Learn about the physical exam and autopsy clause commonly found in health insurance policies. Understand its implications and what it means for policyholders and their families.
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.
Get a comprehensive overview of the Summary Plan Description (SPD) in health insurance, detailing all available benefits under a specific plan.
Dive deep into the unpaid premium provision in health insurance, an important clause that permits unpaid premiums to be deducted from claim payments. Learn how this provision can impact policyholders and claims.
Learn about the role of a third party payor in health insurance, such as Medicare or Blue Cross/Blue Shield, and their importance in healthcare coverage.
Learn about triage in health insurance, a critical system used to rank patients based on the severity of their injuries or illnesses, ensuring that those in urgent need receive prompt care.
Learn about Unemployment Compensation Disability Insurance, a health insurance option covering non-workplace accidents and sickness. Does not encompass injuries covered by workers' compensation.
Explore the mandated uniform provisions in health insurance, set forth by the National Association of Insurance Commissioners (NAIC), to understand individual medical policy conditions.
Discover the essentials of Accidental Death and Dismemberment (AD&D) Insurance, a policy that provides financial benefits upon accidental death or incapacitating injury.
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.
Explore the concept of backdating in health and life insurance policies, and understand how adjusting the policy's effective date can result in premiums calculated for a younger age.
Learn about Basic Hospital Plans in Health Insurance. Discover what minimum benefits and basic benefits are provided by these insurance policies.
Learn about benefit triggers in health insurance. Understand the specific conditions that must be met for benefits to be paid out. Comprehensive guide to help you navigate the requirements.
Learn about the concept of a Blanket Contract in health insurance. Explore the definition of blanket insurance and its importance in providing coverage for groups.
Understand the ins and outs of blanket medical expense insurance, a policy that covers various medical costs, with specific exclusions. Learn how it provides broad healthcare protection.
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 Comprehensive Medicare Supplement policies that cover Medicare deductibles and co-insurance amounts for treatments.
Learn about custodial care in health insurance, which includes assistance with personal activities such as eating, bathing, and dressing. This care is given per doctors' orders and does not require a medical professional.
Learn about customized coverage in health insurance, which tailors policies to fit individual needs by combining different types of coverage.
Learn about Dental Plans in health insurance, contracts for dental care either on a prepaid basis or paid afterward, available for individuals and groups.
Learn about Dental Plan Organizations (DPO) in health insurance. Understand their role in providing dental care through agreements with providers.
Learn about the role of a Designated Mental Health Provider in health insurance policies and how they deliver mental health services through medical plans.
Learn how Group Credit Insurance offers protection for debtors by paying or reducing the debt in the event of disability or death. Explore the benefits for both health and life insurance.
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.
Hospital income insurance provides a steady income while an individual is hospitalized, ensuring financial stability. Learn how this insurance covers hospital expenses and other needs.
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 the house confinement clause in health insurance policies, predominantly found in loss of income policies, which requires the insured to be confined at home to be eligible for coverage.
Learn about insurance in force and its significance in health and life insurance policies, including the amount of policies to be paid out and yearly premiums.
Explore the essential details about intermediate care in health insurance, including its definition, benefits, and how it differs from skilled nursing care.
Understand what 'Line of Business' means in the context of general insurance terms, including examples such as Homeowners, Health, and Life insurance.
Explore the concept of Long Term Disability in Health Insurance, where disability conditions persist over a long period of time, and understand its impacts and coverage options.
Learn about the role of a medical examiner in health and life insurance. Discover how they conduct examinations for prospective insured individuals.
Learn about medical expense reimbursement plans and how they provide reimbursement for specified health care-related expenses for employees.
Discover what medically necessary procedures or treatments mean in health insurance, emphasizing their critical role in patient care and the consequences of neglect.
Explore what a Newspaper Policy in health insurance entails. Learn how these limited policies, often sold through newspaper advertisements, aim to boost circulation while offering basic health coverage.
Learn about non-occupational policies in health insurance, which exclude coverage for work-related injuries but are supplemented by workers' compensation.
Learn about nonduplication of benefits in health insurance, also known as coordination of benefits, where benefits do not cover losses already being covered by another party.
Learn about nonparticipating providers in health insurance, including what it means for a provider to not participate in Medicare or health plans.
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.
Discover what the Outline of Coverage in Health and Life Insurance entails. Learn about its role in summarizing benefits, coverage, exclusions, and premiums, and how it functions as a preliminary overview for insurance applicants.
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.
Learn about the per cause deductible in health insurance, a requirement that benefits are only paid after the deductible for each incident is met, and how it impacts your coverage.
Understand the quarantine benefit in health insurance, which compensates for time lost during quarantine enforced by health authorities.
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.
Understand the concept of recurrent disability in health and life insurance, including its definition, implications, and how it affects policyholders. Learn how recurrent disabilities are managed within insurance frameworks.
Learn about residual income in health insurance, a crucial aspect of disability policies that provides benefits for partial disabilities. Discover how these stipulations work and their impact on policyholders.
Understand the 'Restoration of Benefits' clause in health insurance, which allows the insured's lifetime maximum benefit to be gradually restored annually after a claim.
Understand the term 'Schedule' in both Property and Health Insurance. Learn how it lists covered items, procedures, and their costs for comprehensive insurance coverage.
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 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.
Learn about co-pay in health insurance, where the insured pays a portion of the cost for services, and the provider covers the remaining balance.
Discover what currently insured status means under Old Age, Survivors, and Disability Health Insurance, and how it affects survivor benefits for dependents.
Learn about disability benefits, which provide financial support to individuals deemed partially or totally disabled. Explore policies and clauses in health and life insurance.
Learn about Disability Income Insurance, a type of health insurance that provides financial support when you are unable to work due to sickness or injury. Explore how it helps replace your regular income.
Learn what Disability Insured status means in health insurance, how it is granted by the SSA, and the requirements involving social security taxes.
Learn about dismemberment benefits in health insurance, including how these benefits are paid out upon the dismemberment of the insured.
A comprehensive guide to drug formulary in health insurance, detailing the list of approved prescription medications covered by the plan and available through affiliated pharmacies.
Explore the drug price review process in health insurance, using the American Druggist Blue Book to determine wholesale medication costs and set maximum drug prices.
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 eligible expenses in health insurance—medical costs or other charges that are covered under the health plan contract.
Learn about what constitutes an emergency in health insurance, defined as an illness or injury with a sudden onset that requires immediate medical attention.
Explore the key features of employee benefit programs, focusing on employer-provided health and life insurance to cover medical care, death, and disability expenses.
Learn about the future increase option in health insurance, an option to augment disability benefits without re-establishing insurability. Available at predetermined times listed in the contract.
