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What is an Accidental Death Benefit?
An Accidental Death Benefit is an additional benefit, which usually is equal to the principal sum or the face of the contract. The Accidental Death Benefit is paid in addition to other benefits, upon the death of an individual, assuming the death was the result of an accident.
What is AIDS - HIV Risk Coverage?
AIDS-HIV Risk Coverage is health insurance coverage for people working in the health care industry who might become infected with HIV (human immunodeficiency virus) or AIDS (acquired immune deficiency syndrome) by coming into contact with patients or patients fluid specimens. Health Insurance may be paid monthly to cover expenses or it may be payable in a lump sum.
Most health insurance policies only offer limited amounts of coverage for someone becoming infected with HIV or Human immunodeficiency virus or acquired immune deficiency syndrome.
What is Alcoholism?
Alcoholism is the addiction to alcohol which usually includes excessive or chronic use of alcoholic beverages. It often involves an increased adaptation to the effects of alcohol over time and therefore greater consumption of alchohol which results in impaired health Health Insurance is usually not available to alcoholics on a standard basis, but only through state health insurance risk pools.
What is Alternative Medical Treatments?
Alternative Medical Treatments are health care treatments that are different from traditional or conventional Western medicine and surgery, such as herbal treatments, homeopathy, or acupunture. Some health plans cover such treatments, but many do not.
What is an Assignment of Benefits?
An Assignment of Benefits is a situation where the person in receipt of the medical benefits makes an assignment of the benefits. The benefits are assigned or given to a hospital or doctor or other health care provider.
What is Alzheimer's Disease?
Alzheimer's Disease is a very progressive disease, which is currently irreversible, and manifests itself by degeneration of brain cells and severe memory loss. This results to the individual becoming dependent upon others for basic living needs. (H
What is a Beneficiary?
A Beneficiary is someone eligible for benefits under a health insurance policy.
What is Blood Pressure?
Blood Pressure one of the factors used in life insurance and health insurance coverage for evaluating the risk. High blood pressure or hypertension may result in a greater incidence of accident or illness, and may also lead to less favorable mortality and morbidity factors, or increased rates for life insurance and health insurance.
What is a Business Overhead Expense Policy?
A Business Overhead Expense Policy is a disability income policy purchased by the owner of the business to protect the business for certain covered overhead expenses that occur when the business owner is totally disabled.
Can I be Singled out for Cancellation of my health insurance policy.?
No, you can't be singled out for cancellation of your policy by your insurance company due to medical or health conditions.
What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a disorder or inflammation of the tendons in the wrist, resulting from continuous or repetitive movement, which causes pain or tingling in the hand and writs.
What is a Catastrophic Hospital Policy?
A Catastrophic Hospital Policy is a Major Medical Policy.
What is COBRA?
COBRA is a Federal law giving employees the right to continue group health insurance coverage for a certain specified period of time, if the employee loses his or her coverage due to fewer work hours or the loss of their job.
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What is a Cognitive Impairment?
A Cognitive Impairment is a condition that can be insured by purchasing a Long Term Care insurance policy. The insurance coverage would come into effect if the insured should have a loss of awareness and judgment or a cognitive impairment. A good example of a cognitive impairment would be someone who develops Alzheimer's disease or senility.
What is Coinsurance?
Coinsurance is the part of the medical costs that are shared by both the insured person and the insurance company. For example, if you have an 80% to $10,000 coinsurance plan;
The insurance company (Insurer) is responsible for 80% of the next $10,000 of covered medical expenses after the deductible is paid by insured.
The Insured person is responsible for 20% of the same $10,000 in covered medical expenses after the deductible is paid.
In this above mentioned example with a $1,000 deductible and 80% coinsurance to $10,000 of covered expenses, if the actual costs of the medical expense were $10,000 the insured would be responsible for paying the deductible ($1,000).
Of the next $9,000 in covered expenses, the insured would pay an additional 20% coinsurance. For this example the insured would pay 20% of the remaining $9,000 of covered expenses, after the deductible. The insured would pay $1,800 and the Insurer would pay $7,200.
What is Coordination of Benefits?
Coordination of Benefits provision, in a health insurance contract happens, when a person is covered under more than one health insurance plan. The Payment of benefits must be coordinated by all health insurance plans owned by the insured, in order to eliminate duplication of benefits or being over insured.
What is a Covered Expense?
Covered Expenses are those services on a health insurance plans that are not covered. Some times a doctor office copay may not be a covered expense, or a prescription drug may not be a covered expense on an outpatient basis. Covered services are those medical procedures for which the insurer has agreed to pay. They are listed in the policy contract.
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What is Creditable Coverage?
Creditable Coverage is health insurance coverage that a person had previous to purchasing their current health insurance plan. This health insurance coverage may be used to shorten the time of the pre-existing condition waiting period.
What is the Denial of a Claim?
The Denial Of Claim comes about when a health insurance company refuses to pay a claim for an individual or his provide for health care services received from a health care professional.
What is a Deductible in a Health Insurance Policy?
A Deductible is a predetermined amount of money that an insured must pay before the Insurance Company is required to make any benefit payments. The purpose of a deductible is to keep costs reasonable for the insured person. The higher the deductible, usually the lower the price of health insurance coverage and the lower the deductible the higher the price of health coverage
Does a Deductible have to be met before Office Visits are covered by my Doctor Office Copay?
Usually a Deductible does not have to be met or paid. There may be, however, some companies where this is not true, although it would be unusual.
What is Dental Insurance?
Dental Insurance is insurance coverage for dental services, and is usually found in an employee benefit plan or included in a health insurance policy. Sometimes a separate dental policy or plan is purchased. It usually includes a coinsurance provision and may emphasize preventative care. Many dental plans pay all of the costs for annual teeth cleanings and also for routine check-ups twice a year.
What is Dependent Coverage?
Dependent Coverage or, dependent health insurance coverage, is health insurance coverage has been purchased by an adult parent, which then allows the parent to insure his spouse, and his or her child or children. The spouse and unmarried dependent children may be insured as dependents. Children qualifying normally include natural children, step children, and sometimes foster children, as well. Some age restrictions on children normally apply.
What is a Doctor Office Copay?
A Doctor Office Copay is the price a patient pays for his or her doctor visit. In many cases, any costs from that visit are covered at 100% after the doctor office copay. Often, lab tests, Blood work ups, MRI's, etc. are not included in the doctor visit, but are covered after the deductible is met.
Are my Doctor Office Co-payments credited against my deductible?
No, Doctor Office Co-payments are not usually credited toward meeting the deductible on a health insurance plan. Major expenses, however, like hospital stays, are credited toward meeting the deductible, as long as they are covered expenses.
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How many Doctor Visits are covered under the Doctor Office Copay?
The number of Doctor Visits varies between health insurance companies. Some companies offer as few as 2 visits and other insurance companies may have an unlimited number of covered doctor visits. The cost for these unlimited doctor visit plans can be very expensive, however.
What is the Effective Date?
The Effecive Date is the date that the health insurance coverage becomes effective or inforce, or the day the health insurance begins.
What is an Eligible Dependent?
An Eligible Dependent is a dependent of a person covered for health insurance. An example could be, a spouse, child, or another dependent as noted in the health insurance contract. There is an additional premium required for the dependent.
What is Evidence of Insurability?
Evidence of Insurability is giving medical records or the information necessary for the underwriting of an insurance policy.
What is an Emergency?
An Emergency is there is a disease or injury which suddently occurs, and then needs to be treated during the next 24 hours.
What are Exclusions and Limitations
Exclusions and Limitations are medical services in an insurance contractthat are not covered or have benefit limitslimited in benefit by a health insurance insurance policy.
What is an Exclusion Period?
An Exclusion Period is that time period during which an insurance company can delay the actual coverage of a preexisting condition. This is sometimes this called a pre-existing condition waiting period.
What is an Experimental Procedures Exclusion?
An Experimental Procedures Exclusion is an exclusion found in most health insurance policies, which excludes experimental or investigative medical procedures, equipment or drugs from insurance coverage based on the fact that they have not been proven to be medically effective.
In order to evaluate how effective these experimental procedures are, many insurers refer to clinical reports or tests from medical field, scientific institutions or government agencies.
What is Fee for Service?
Fee for Service is a system for health care where the provider is paid only for each actual service rendered, as opposed to a pre-negotiated amount for each patient.
What is First Dollar Coverage?
First Dollar Coverage health insurance that has a provision that doesn't require an insured to meet a calendar year deductible before receiving payment for a medical service.
What is a Flat Benefit?
A Flat Benefit is a actual specified dollar amount payable for certain covered medical expenses listed in a health insurance policy. An example might be $500 per day when hospital confined.
What is a Free-Look Period?
A Free-Look Period is usually a 10-day period of time where a new insured can cancel a health insurance policy and still receive a full refund of premium paid.
What is a Full Time Student?
An eligible dependent student is considered a Full Time Student Under a health plan, normally age 19 or older, who meets the health insurance plan's guidelines of full time. Normally to be considered a full time student requires a minimum of 12 credit hours in a semester. The maximum age of a student is normally 23 or 24.)
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What is a Generic Drug?
A Generic Drug is a prescription drug which has the same ingredients as a brand name drug. A Generic Drug may be produced after the expiration of a brand name drug's patent. Another name for a Generic Drug is generic equivalent.
What is a Group Health Insurance?
Generally Group Health Insurance is a policy of insurance that an employer applies for with an Insurance Company. The employer is required to pay some part or percentage of the the employee's premium and the employee must work some minimum number of hours per week.
The employer may choose to pay a greater portion of the required premium than the minimum, but is not required to do so. In some states Group Insurance is Guaranteed Issue, which means that the Insurance Company is not able to decline any applicant.
What is Guaranteed Insurability?
Guaranteed Insurability, in a health insurance policy, is a provision included in a health insurance policy at the time of purchase, that allows an individual to purchase additional health insurance benefits at some future date.
An example of a benefit might be higher benefit limits, and the insured is not required to provide additional evidence of insurability.
What is Guarantee Issue?
Guaranteed Issue is a when an insurance company doesn't require employees to provide any evidence of insurability in order to apply for health insurance coverage. This type of insurance coverage is usually available only on a group insurance plan.
Usually the amount of insurance coverage provided is determined by the size of the group and the ages of the individual employees to be insured. Some states require health insurance companies to offer some minimum basic type of health insurance coverage to small businesses on a guaranteed issue basis.
What is a Health Care Provider?
A Health Care Provider is a term often used for professionals in health care who provide health care services. The term may refer to a physician or other health care professionals as well, including hospitals, chiropractors, physical therapists, nurse practitioners, and speech therapists.
What is a Health Indemnity Plan (Hospital Indemnity Plan)?
A Health Indemnity Plan or a Hospital Indemnity plan is Health Indemnity Plan is a health insurance plan that reimburses the insured, after the insured has paid for his own covered medical expenses. The payment to the insured is less any co-payment or deductible.
What is Health Insurance?
Health Insurance is insurance protection form a loss by sickness or accidental bodily injury. Health Insurance is also the term for types of insurance that provide lump sum or periodic payments upon a loss due to sickness, disease or injury to the body.
We now use the phrase Health Insurance instead of Sickness Insurance, Accident Insurance, Accidental Death Insurance, Medical Expense Insurance, or Dismemberment Insurance. Health Insurance is sometimes referred to as Accident and Sickness, Accident and Health Insurance, Accident Insurance, or Disability Income Insurance.
What is is a Health Maintenance Organization (HMO)?
A Health Maintenance Organization (HMO) is a plan that requires you choose a doctor who then becomes your primary care physician. In order to go to a specialist you must first get permission from your primary care physician.
What does HIPAA Mean?
HIPAA is the Health Insurance Portability and Accountability Act, which is a federal law that guarantees health insurance plan eligibility for people who change jobs, assuming the new employer offers group insurance.
What is a Hospital-Surgical Coverage
Hospital-Surgical Health Insurance Coverage is a kind of health insurance that provides coverage for certain medical costs related to a hospitalization stay and also surgical procedures. A hospital-surgical plan does not cover outpatient medical services, such as doctor office visits, x-rays, lab tests and outpatient prescription drugs.
What is an Impaired Risk?
An Impaired Risk is a prospective insured applicant who has either a preexisting medical condition, is in poor physical condition, has a dangerous occupation, or has dangers avocations such as race car driving.
What is an Incontestable Clause?
An Incontestable Clause is a provision in a health insurance contract, which states that after a specified time period, which is normally 2 years, the insurance company may no longer contest any statements made by the insured on the application.
A provision in life and health insurance policies that once a policy has been in effect for a specified period of time (e.g., two years), an insurer can no longer contest statements in the policy application in order to deny claims or void coverage.
What is an Individual Insurance Contract?
An Individual Insurance Contract is a contract made with an individual, who is the insured, and an insurance company, who is the insurer, that covers the individual, and many times members of his family, for health insurance benefits, as specified in the health insurance policy.
What is a Lapse?
A Lapse is termination of a health insurance policy for non-payment of premiums.
What is a Legend Drug?
A Legend Drug is a drug which has been labeled caution: federal law prohibits dispensing without a prescription.
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What is a Major Medical Plan?
A Major Medical Plan is health insurance plan that has insurance coverage for expenses due to hospital confinements, surgery either inpatient or outpatient, or other medical conditions requiring a large range of medical services and supplies.
What is Managed Care?
Managed Care is a kind of medical care system whose goal is to manage the cost and quality of medical care services. Most managed care systems offer HMO's and PPO's, which individuals are encouraged to use for their health care needs. Some managed care plans strive to improve health quality by emphasizing prevention of disease.
What is a Master Policy?
A Master Policy is a group health insurance policy that has an explanation of health insurance coverage to all group members.
What is a Maternity Benefit?
A Maternity Benefit is health insurance that covers the medical surgical and hospital expenses of an insured during her childbirth or pregnancy. It also provides insurance coverage for a miscarriage or involuntary abortion and health care for the newborn. Most health insurance policies pay only a limited or fixed dollar amount. Some plans, usually group health insurance plans, cover the actual expenses. Insurance coverage for childbirth is usually excluded in most individual health insurance policies, but is usually a covered expense in most group health insurance policies.
What is a Maximum Dollar Limit?
A Maximum Dollar Limit is the total amount of money that an insurance company will pay for claims within a specified time period. The maximum dollar amount limits vary between companies. They may be based or defined in terms of kinds of illnesses or types of services. The terms may be for a lifetime or sometimes only for a year or less.
What is a Medical Savings Account (MSA)?
A Medical Savings Account (MSA)is a tax favored personal savings account which is used along with a high deductible health insurance policy. Individuals may contribute money to this account on a pre-tax basis in order to be able to accumulate money for qualified medical expenses and care.
This accumulated money can be used to reimburse the insured for deductibles, copayments and other health care expenses not covered by the health insurance policy.
What is Medical Expense Insurance?
Medical Expense Insurance is Medical Expense Insurance Health Insurance that provides benefits for hospital, surgical, and medical expenses. Medical Expense Insurance also includes health insurance coverage under the name Medical Care Insurance and Hospital-Surgical Expense Insurance.
What does Medically Necessary mean?
Medically Necessary in a health insurance policy means a policy that excludes insurance coverage for medical treatment that is not considered medically necessary.
What is a Mental Disorder?
A Mental Disorder is an emotional or organic mental impairment, a psycho neurotic or personality disorder or any psychiatric disease that has been identified in a medical manual which classifies such diseases. A good example would be the American Psychiatric Association's Diagnostic and Statistical Manual.
What is a Network Provider?
A Network Provider is the hospitals, physicians, or other medical care providers that have agreed to be network participants, and also to offer their services at negotiated rates. They have also agreed to the negotiated contractual provisions. A Network Provider is also known as a participating provider.
What is a Non-cancellable Policy?
A Non-cancellable Policy is an insurance policy that guarantees the insured to be able to keep the insurance, as long as the premiums are paid. It is also known as a guaranteed renewable policy.
What is a Non-Participating Provider?
A Non-Participating Provider is, either a health or medical care provider who has not yet been certified to be a participant in the Medicare program, or a medical care provider who has not yet signed a contract with a health plan.
What does Non-Renewable Mean?
Non Renewable means that an insurance policy that may not be continued or renewed after its expiration date.
What is Open Enrollment Period?
Open Enrollment Period is a time when members can elect or decide to come under an different health insurance plan, normally without evidence of insurability.
What is Out-Of-Pocket Maximum?
An Out-of-Pocket Maximum is an insured's out-of-pocket costs, that must reach a predetermined specified dollar amount, and which must be paid out of the insured's own funds. After this point is reached an insurance company will pay 100% of all remaining covered charges through the end of the benefit period, which is often a calendar year.
Can Smokers be Charged More Money than Non-Smoker?
Yes. Smokers pay rates up to 40% higher than nonsmokers for a health insurance policy with the same benefits.
Does it Cost more to Buy a Policy from an Insurance Agent than Directly from the Insurance Company? 
No, it does not cost any additional money to purchase a health insurance policy from a health insurance agent. Working with an insurance agent, you are actually working with the insurance company.
Agents are required to be approved by insurance companies and also are required to represent the insurance company in a fairly.
There are no extra fees to pay for an agent's services. Actually there is a great benefit in working directly with an agent. You may be able to get several health insurance quotes while making only one phone call.
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What is a Participating Provider?
A Participating Provider is a health care provider, approved by a Preferred Provider Organization (PPO) network to participate in the program, and receive benefit payments directly from insurance companies.
What is a Physical Therapist?
A Physical Therapist is a medical professional who is trained, and who provides therapy and rehabilitative services, in order to help restore normal bodily functions such as speech, walking, the use of limbs and things of that nature.
What is a Point of Service Plan?
A Point of Service Plan is a type of plan that gives members of the plan the option of using medical services outside of the HMO network, without receiving approval first.
What is Pre-Admission Certification?
Pre-Admission Certification is frequently called pre-admission review or pre-certification review. This process requires prior approval by a case manager or representative of an insurance company(usually a nurse) for an insured person to be admitted to a hospital or in-patient facility.
The process of Pre-Admission Certification must often be secured by the individual prior to admission to the hospital or other inpatient facility.
Often, however, physicians or their personnel will contact the appropriate individual on your behalf. The goal of pre-admission certification is the ensure that insureds are not given inappropriate health care services which may not be medically necessary.
What is a Pre-Admissions Review?
A Pre-Admissions Review is a review of an insured individual's health care status prior to the insured person is admitted to an inpatient health care facility or hospital. Pre-admission reviews many times are performed by case managers or insurance company representatives. Nurses normally do these pre-admission reviews with the help of the insured individual, his or her health care provider, or physician and the hospital.
What is Pre-admissions Testing?
Pre-admissions Testing is when medical tests that are done for an insured individual before he or she is admitted to a hospital or inpatient health care facility
What is a Preexisting Condition?
A Pre-Existing Condition is a clause that excludes a medical condition from coverage by an insurance company since the condition is believed to have existed prior to purchasing a policy from the particular insurance company.
What is a Preferred Provider Organization (PPO)
With a Preferred Provider Organization (PPO) you many receive lower costs (discounts) from the provider hospitals, doctors, and other health care service providers within the network. The provider network is usually quite large. The cost is usually higher when you use a provider outside the PPO network. You also have the right to choose any provider within the network.
These primary care physicians are often called gatekeepers since they are required to be seen before a referral to a specialist will be approved.
An HMO does not allow you the freedom of choice many people would prefer. HMO's are no longer as prevalent or popular as they once were.
What is Preventive Care?
Preventive Care stresses preventive care programs, such as health screenings, routine check ups, immunizations, diagnostic lab and x-ray, testing, well-baby or child care, pap smears, mammograms and other preventive care tests. The reason for providing health insurance coverage for preventive care, is for early detection of disease, in order to make it more treatable, and finding medical conditions earyly make them less expensive to treat.
What is a Primary Care Physician?
A Primary Care Physician is either a general practice doctor, an internist, a family physician, a pediatrician or an obstetrician or gynecologist. People enrolled in an HMO, generally must choose a Primary Care Physician from a list of participating providers. The Primary Care Physician takes care of you for most things and makes referrals to specialists, as needed.
What are Reasonable and Customary Fees?
Reasonable and Customary Fees are the average fees charged by a particular type of health care professional, within a certain geographic area. This fee is the amount of money that an insurance company will approve for a specific procedure or test. 
If the fee charged is higher than the approved fee, then the individual receiving the service is required to pay the difference. Sometimes, however, if an insured questions his physician about his fee, the doctor will in many cases reduce his charge to the amount that the insurance company has defined as reasonable an customary.
What is a Schedule (Surgical)?
A Schedule (Surgical) is a list of specified dollar amounts of money payable for particular dismemberments, surgical procedures, and ancillary expenses in medical reimbursement and hospital policies.
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What is a Second Surgical Opinion?
A Second Surgical Opinion is a procedure used to control medical costs and to help insurance companies and patients decide, whether or not, a surgical procedure that is recommended is actually necessary. A Second Surgical Opinion is also used to decide, whether or not, another different method of treatment might accomplish the same result at a lower cost. Some health policies require a second surgical opinion before certain medical procedures will be covered, and many policies pay for the second opinion.
What is Sickness Health Insurance?
Sickness Health Insurance is a type of health insurance plan that helps protect from a loss by disease or illness. It does not cover accidental bodily injury.
What is a Skilled Nursing Facility?
A Skilled Nursing Facility is a facility designed specifically in order to qualify for treatment to people eligible for Medicare. A Skilled Nursing Facility includes treatment for rehabilitation, physical therapy, occupational therapy, speech therapy and other additional care like 24-hour nursing coverage.
What is a Specialist?
A Specialist is a doctor who has been trained in specialty area of medicine in which he practices, such as a gastro enterologist or dermatologist. People enrolled in an Health Maintenance Organization or HMO, you usually will need a referral from your primary care physician to see a specialist.
What is a Surgical Schedule?
A Surgical Schedule is is normally one part of a basic medical expense plan which lists or itemizes many different surgical procedures and the monetary cost or benefit allocated to each surgical procedure.
What is a Traditional Health Insurance Plan?
In a Traditional Health Insurance Plan or an Indemnity Plan an insured may choose any doctor or hospital for his or her medical care. These plans have a deductible, co-insurance, and stop loss amounts like those available on PPO plans.
However, with a Traditional Plan you can go directly to a specialist without having to first go to a primary care physician as is required in an HMO Plan. 
What is Travel Accident Insurance?
Travel Accident Insurance is a kind of health insurance that limits insurance coverage to accidents that happen while the insured is traveling.
What is a Waiting Period?
A Waiting Period is a period of time during which you are not covered by your health insurance policy for a particular condition or problem.
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