Accelerated Benefit - A rider on a life insurance policy which allows the policyholder to take an advance from the policy if the policyholder has been diagnosed with a terminal illness. Usually the benefit paid is 50% of the total benefit.
Co-Insurance - Arrangement by which the insurer and the insured share, in a specific ratio (80/20), payment for losses covered by the policy after the deductible is met.
Deductible - The amount of covered expenses that must be incurred and paid by the insured before benefits become payable by the insurer.
Disability Income Insurance - Insurance that provides payments to replace income lost due to a disability either by sickness or injury.
Maximum Out-of-Pocket - The amount of money an insured will pay in a benefit period in addition to regular premium payments. Once the maximum out~of-pocket amount is met the plan usually pays 100% in the same benefit period.
Pre-Existing Condition - An injuryorsickness that manifested itself before the policy was issued. A condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
Pre-Existing Condition Claus - A health insurance policy provision stating that benefits will not be paid for any pre-existing condition until the insured has been covered under the policy for a specific period.
Reasonable and Customary Charges (REtC) - Amounts charged by healthcare providers that are consistent with charges from similar providers for identical services in a given locale. Most carriers will pay at the 80th percentile of REtC.
State Contirwation - Allows terminated policyholders to continue health insurance coverage for up toB months if they meet certain criteria.
Qualifying Event - A death, termination, divorce, birth of a child, adoption, change in dependent status, reduction of hours, Medicare entitlement.