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 the concept of an indexing year in health insurance, crucial for calculating social security benefits effectively.
Comprehensive guide to Long Term Care (LTC) in health insurance, focusing on the services and care for individuals with diseases or disabilities.
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.
Learn about the significance of medical examinations for health and life insurance policies. Discover how these physical evaluations, performed by a doctor on behalf of the insured, impact your coverage.
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.
A comprehensive guide to Minimum Premium, explaining its definition, significance, and application in both health and general insurance contexts.
Learn about the misstatement of age in health and life insurance policies, including the consequences of providing a false age when applying for a policy.
Explore the concept of morbidity rate in health insurance, a metric that compares the frequency of illness to the number of healthy individuals within a specified time frame.
Learn about morbidity tables in health insurance, which are used to show the frequency of illness at specific ages. Discover how these tables are instrumental in assessing health risk and setting premiums.
Discover how mortgage insurance can provide financial security by covering mortgage payments in case of death or disability. Learn how this policy functions and its benefits.
Learn about nursing homes, also known as long-term nursing facilities, licensed centers providing care for individuals unable to care for themselves or suffering from chronic illness.
Learn about partnership insurance, a crucial life and health insurance product for businesses. Discover how cross purchase and entity plans help partnerships continue operations after the death or dismemberment of a partner.
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 preexisting conditions in health insurance, how they affect coverage, and what regulations apply. Essential for navigating health policies effectively.
Learn about primary care in health insurance, focusing on medical care provided by a primary physician. Discover its importance and benefits.
Learn about qualifying events in health insurance, which trigger changes in coverage such as death, birth, or job loss.
Learn about Resource Based Relative Value Scale (RBRVS), a method used by Medicare to determine compensation for doctors, and its implications in the health insurance industry.
Learn about secondary care in health insurance, which involves specialized medical attention typically provided upon referral from a primary care physician.
Discover the essentials of Service Plans in health insurance, where provided services are treated as benefits rather than monetary payouts.
Learn about the Attending Physician Statement, a crucial document detailing an individual's medical information used in health and life insurance policy underwriting.
Learn about the Explanation of Medicare Benefits, a statement mailed to Medicare participants detailing the payment for their claims. Find out how it informs beneficiaries about covered services and payments.
Discover the benefits of the Free Look Period in Health and Life Insurance policies. Learn how you can review and decide without commitment.
Comprehensive guide on the Relation of Earnings to Insurance clause, explaining how disability income benefits are adjusted to the insured's earnings, with a refund on excess coverage.
Learn about the Relative Value Schedule in health insurance. Discover how it lists surgical costs and values, providing an accurate fee for each procedure.
Learn about the war clause in health and life insurance policies, which excludes coverage for losses caused by acts of war.
Learn about the Transportation Ticket Policy, a specific health insurance policy offering coverage against accidental death and dismemberment during a trip on a common carrier.
Explore the benefits of Vision Care Coverage in Health Insurance, including eye examinations and vision aids like glasses and contacts. Learn how these plans can help you maintain optimal eye health.
Understand Yearly Renewable Term (YRT) life insurance policies and their renewability, along with its implications in reinsurance, where the reinsurer assumes only mortality risk.
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.
Learn about the Certificate of Authority in health insurance, a state-issued certificate crucial for the licensing and operation of health maintenance organizations.
Learn about the definition and certification process for chronically ill individuals in the context of health insurance. Understand the requirements and who can provide certification.
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.
Understand the cost contract between health care providers and the Health Care Financing Administration, ensuring the provision of services at reasonable costs for covered individuals.
Learn about the credentialing process in health insurance, which endorses health care providers to participate in or provide care under health care plans.
Understand credit insurance, a vital policy that ensures your debts are handled if you die or become disabled. Learn how it protects your financial obligations in both life and health scenarios.
Understand the concept of Deductible Carryover Credit in health insurance. Charges from the last quarter of the year that are applied to the next year's deductible.
Understand what dental insurance is, how it works, and what services are typically covered under a group contract.
Learn about Dread Disease Policy, a specialized health insurance that covers all medical costs associated with treating specific medical conditions listed in the policy.
Understand the Eligibility Date in health insurance: the crucial date when insured individuals can start receiving benefits. Learn more about how this date impacts your health insurance claims and coverage.
Explore the conditions necessary for eligibility under group health insurance and pension plans. Understand the key factors that determine eligibility requirements for coverage.
Understand the concept of employee contribution in health insurance and pension plans. Learn how premiums and retirement deductions work.
Learn about the evidence clause in general insurance. Understand its significance, the obligations it places on the insured, and how it aids claim legitimacy and investigations.
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 extended care facilities in health insurance, including their definition, role, and regulations under local and state laws.
A Family Expense Policy in health insurance provides coverage for medical costs of all family members under a single plan, ensuring comprehensive healthcare for your loved ones.
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.
Learn about Guaranteed Insurability in health and life insurance. Discover how this contract option allows you to purchase extra insurance without proving insurability again.
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 illegal occupation provision in health insurance policies. Discover how this clause excludes coverage for losses due to criminal activities or working in illegal occupations.
Understand impaired risk in health and life insurance — a term describing individuals in less-desirable conditions, such as health insurance applicants with multiple heart attacks.
Understand what in-area services mean in health insurance, focusing on the health care services provided within a designated geographical area as per the contract terms.
Discover the significance of the Initial Eligibility Period in Health Insurance, allowing prospective insureds to apply for coverage without proving insurability.
Learn about the Integrated LTC Rider in health insurance policies, which states that Long-Term Care (LTC) benefits will reduce the policy’s other benefits if paid out.
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.
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 legend drugs, which are medications that require a prescription according to federal law. Understand their significance in health insurance.
Understand the concept of a Living Benefits Rider, a significant health insurance rider offering long-term care benefits for terminally ill insured individuals when attached to a life insurance contract.
Understand the Major Hospitalization Policy in Health Insurance, which offers extensive coverage for expenses incurred from the point of hospitalization. Learn how this policy helps in mitigating healthcare costs.
Discover what medical supplies are deemed necessary for the treatment of illnesses or injuries and how they are covered under health insurance policies.
Medicare is a government-run and funded health insurance plan that covers hospital and medical costs for individuals typically older than 65. Learn about Part A and Part B options.
Learn about Member Certificate in Health Insurance, which is synonymous with a Certificate of Coverage. Understand its importance and uses.
Learn about the essential supplies needed to treat mental illness, substance abuse, and alcoholism, covered under health insurance.
Learn about mixed insurers/companies in the insurance domain. Understand their structure of being owned by both stockholders and policyholders, and their scope in writing both life and health contracts.
Learn about the net level premium reserve, the crucial reserve an insurer must maintain to pay net level policies in their later years efficiently.
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 noncontributory health and life insurance where the employer covers the full premium, relieving employees from any contribution. Ideal for understanding employer-sponsored insurance benefits.
Explore the concept of percentage participation in health insurance, detailing how insurers and insureds share the cost of claims based on agreed terms.
Learn about the physician contingency reserve in health insurance, a fund composed from claim deductions aimed at motivating appropriate healthcare provision.
Learn about pre-admission authorization in health insurance, a required step for obtaining insurer approval before hospitalization.
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.
Learn about the principal sum in health and life insurance, the total amount paid for accidental death, and the percentage paid for dismemberment.
Explore the concept of prospective reimbursement in health insurance where providers receive annual payments based on previously established rates. Learn how this system impacts healthcare providers and patients.
Learn about Qualified Medicare Beneficiary (QMB), who qualifies for Medicare benefits due to income being under the federal poverty guidelines.
Learn about Quality Assurance in health insurance, the essential process of reviewing and enhancing the quality of health services and coverage. Discover its importance and methodologies.
In health insurance, the term 'revenue' is often used interchangeably with 'premium.' Learn about the importance of premiums and how they impact your health coverage.
Learn about Short Term Disability Income Policies, which offer disability income benefits for a short-term period, generally less than two years.
Understand the meaning of a Subscriber in Health Insurance. Learn who is eligible for enrollment and who pays the premiums.
Understand therapeutic alternatives in health insurance. These are different drugs with varying chemical makeups that provide the same results for patients. Learn more about how they impact healthcare choices and insurance coverage.
Discover what an unallocated benefit in health insurance means, how it works, and its implications on health care expenses without a corresponding schedule of benefits.
Learn what the average semi-private rate means in health insurance. Discover how this charge is determined for semi-private hospital rooms in your area.
Explore the concept of blanket insurance in both health and property insurance, where entire groups or multiple types of properties are covered under a single contract.
Learn about bodily injury in health insurance, which covers physical damage to a person's body. Discover what this term means and its implications for your healthcare coverage.
Learn about coinsurance in both property and health insurance: how it determines claim payments in property insurance and the policyholder's cost responsibilities in health insurance.
Learn about contributory plans where employees contribute to their premium in health and life insurance policies.
Explore what conversion privilege means in health and life insurance, including how it allows insured individuals to switch from group to individual policies upon leaving a group.
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.
Explore the significance of policy delivery in health and life insurance. Understand the process and its importance in ensuring insurance coverage.
Discover how Diagnosis Related Groups (DRGs) are used to determine compensation for medical providers in the health insurance industry.
Discover how a Disability Buy Sell policy funds an agreement to purchase the interests of a disabled stockholder. Learn more about buy sell agreements in health insurance.
Learn about the 'Fee Schedule' in health insurance, which outlines the maximum charges for providers operating on a fee-for-service basis.
Explore the concept of funding level in health insurance, which refers to the amount needed for a medical care program whether through premium costs or anticipated claim loss and fees.
Learn about group certificates provided to policyholders in group health and life insurance plans, detailing the benefits offered under the group policy.
Learn about group contracts in health and life insurance, including benefits, coverage details, and eligibility for employees under a single employer.
A comprehensive guide to recipients in health insurance, focusing on eligibility criteria and benefits under the Medicaid program.
Learn about the illegal high-pressure tactics used in selling health insurance policies and how to identify and prevent being a victim. High-pressure tactics often involve threats, intimidation, or coercion, especially in marketing Medicare supplemental policies.
Comprehensive guide on the length of stay in health insurance, which refers to the total number of days an insured individual stays in a hospital or similar medical facility. Learn its impact on insurance claims and healthcare costs.
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.
