Adverse selection refers to a scenario in the insurance industry where individuals more prone to filing claims are more likely to seek insurance coverage, leading to potential imbalances for insurance providers.
A health insurance policy providing broad coverage for an insured's medical expenses, except those explicitly excluded. This type of policy is highly advantageous for insured individuals as any non-excluded medical expenses are automatically covered.
Blue Shield is an independent, nonprofit, membership-based insurance plan that offers benefits covering expenses associated with medical and surgical procedures.
Coverage providing funds for maintenance of a business as closely to normal as possible in the event of a loss of a key person, owner, or partner.
An arrangement that allows employees to choose their own employee benefit structure, tailoring it according to their personal needs and preferences.
COBRA is a federal law that allows employees and their families to continue their group health benefits even after losing their job or experiencing other qualifying events.
Employee insurance covering a part of the incurred cost for dental and vision care. The deductible portion and total coverage of the plans vary according to the insurer and the workplace.
Protection under life and health insurance policies for dependents of a named insured, including a spouse and unmarried children under a specified age.
Disability Income Insurance is a type of health insurance that provides income payments to the insured wage earner when income is interrupted or terminated because of illness, sickness, or accident.
Duplication of Benefits refers to the situation where an individual has coverage for the same insured loss under two or more health insurance policies. In such cases, the policies either pay proportionate shares of the loss or one policy is designated as primary and the other as secondary.
Employee contributions refer to the workers' premiums or payments toward a contributory employee benefit plan. These contributions are often made to plans such as health insurance, retirement funds, and other employer-sponsored benefits.
A fixed premium is a payment for insurance coverage that remains the same throughout the entire premium-paying period.
In the context of insurance, full coverage refers to an insurance policy that covers all insured losses in full, without leaving the policyholder responsible for any out-of-pocket expenses related to a covered event.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) includes rules to guard both the privacy and security of personal health information. It provides federal protections for personal health information held by covered entities and stipulates a series of safeguards to ensure the confidentiality, integrity, and availability of electronic protected health information.
A Health Maintenance Organization (HMO) is a type of prepaid group health insurance plan that entitles members to the services of participating physicians, hospitals, and clinics with an emphasis on preventive medicine.
A form of health insurance that covers hospital stays and related medical costs, such as medicines and physicians' services. Many organizations provide at least part of the cost of hospitalization insurance for their employees, with coverage varying depending on the specific policy.
Insurability is the circumstance in which an insurance company can issue life or health insurance to an applicant based on standards set by the company. It evaluates the risk and determines if the applicant qualifies for coverage.
An individual or entity whose interests are protected under an insurance policy designed to indemnify against loss of property, life, health, etc.
Key Person Life and Health Insurance is a type of business insurance coverage designed to protect companies from the financial loss that can occur if a key employee becomes disabled or passes away.
Legacy costs are the expenses an employer incurs for providing retiree pensions, health insurance, and other benefits even after an employee has retired. These are ongoing employment-related expenses.
Loss of income insurance provides coverage in property insurance for an employee’s lost income if a peril such as fire damages or destroys the place of employment, causing the worker to become unemployed. Additionally, in health insurance, it compensates for lost income when an insured becomes disabled and cannot work.
A form of supplemental medical insurance that covers medical costs not included under basic health and hospitalization insurance. Typically, the insured is required to pay a deductible before the major medical insurance plan begins to pay for covered services.
Managed care is a health care delivery system organized to manage cost, utilization, and quality. Managed Care Plans are a type of health insurance they have contracts with health care providers and medical facilities to provide care for members at reduced costs.
Jointly administered federal and state government health insurance program provided under Title XIX of the 1965 amendment of the Social Security Act. Medicaid provides health insurance assistance for individuals with low income and limited assets.
Medical care refers to amounts paid for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body, including associated transportation and insurance premiums.
A medical examination, often referred to as a physical checkup, is frequently required for applicants of life and/or health insurance. It helps to ascertain if they meet the insurance company's underwriting standards or should be classified as substandard or uninsurable.
Medicare, a federal health insurance program established under Title XVIII of the Social Security Act, provides basic health coverage to seniors aged 65 and over, individuals with permanent kidney failure, and those under 65 with long-term disabilities, administered by the Health Care Financing Administration with applications handled by the Social Security Administration.
Medigap is a type of health insurance policy designed to cover the areas of noncoverage under Medicare, including deductibles, coinsurance, and medical expenses that exceed Medicare's approved amounts.
Mental Health Insurance policies provide coverage for psychiatric and psychological care, counseling, and often substance abuse treatment, helping individuals manage and afford necessary mental health services.
Falsification of birth date by an applicant for a life or health insurance policy. If the company discovers that the wrong age was given, the coverage will be adjusted to reflect the correct age according to the premiums paid in.
The Open Enrollment Period is a limited timeframe, typically lasting between 10 to 30 days, during which employees who have not previously enrolled in specific types of insurance are allowed to do so. Certain exclusions may apply, such as for preexisting conditions.
Part-time employment refers to jobs requiring less than a full-time commitment from employees. Part-time employees typically do not enjoy the same benefits as full-time employees, such as health insurance and retirement plans.
Partnership life and health insurance provide critical protection to maintain the value of a business in case of the death or disability of a partner. This insurance facilitates the transfer of a deceased or disabled partner's interest to the surviving partners based on a predetermined formula.
Perks are perquisites that come in the form of additional benefits beside regular remuneration, primarily expected by senior employees such as company cars, private health insurance, and gym memberships.
Portability in the context of employee benefits, such as pension and insurance coverage, refers to the characteristic that allows employees to retain their benefits even when they leave their current job to take up a new one with a different employer.
A clause in an insurance policy providing that all policy premiums will be waived if the policyholder becomes seriously ill or disabled, either permanently or temporarily, and is therefore unable to pay the premiums.
