INTRODUCTION TO HEALTH INSURANCE

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INTRODUCTION TOHEALTH INSURANCE
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HEALTH INSURANCE

• Relevant Risks
• Types of Health Insurance
• Medical Expense Coverage
• Disability Coverage

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MEDICAL EXPENSE COVERAGE

• Hospital Expense Coverage
• Surgical Expense Coverage
• Comprehensive Major Medical Insurance

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TYPES OF COVERAGE

• Indemnity plans
• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Point of Service (POS) Plans

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MEDICAL INSURANCE POLICY FEATURES AND DEFINITIONS

• Maximum limits of coverage
• Deductibles
• Coinsurance
• Copayment (copay)
• Adverse selection
• Capitation

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FEATURES AND DEFINITIONS - contd

• Usual and customary
• Internal limits
• Managed care
• Out-of-pocket maximum
• Pre-certification
• Pre-existing Conditions

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INTRODUCTION TO DISABILITY INSURANCE

• Relevant Risk
• Incidence of Risk/Underwriting Considerations
• Risk of misuse
• Underwriting limits
• Social Security definition of disability
• A covered disability is the inability to
  engage in any substantial gainful activity by
  reason of any medical determinable physical or
  mental impairment which can be expected to result
  in death or which has lasted or can be expected
  to last for a continuous period of not less than
  12 months. A person must be not only unable to do
  his previous work but cannot, considering age,
  education, and work experience, engage in any
  other kind of substantial work which exists in
  the national economy. It is immaterial whether
  such work exists in the immediate area . . .

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DISABILITY INSURANCE POLICY FEATURES

• Definition of disability
• Elimination/waiting period
• Available monthly benefit
• Maximum benefit period
• Renewal provisions
• Taxability