Chapter 9. Other Health Insurance Concepts

1. What are the owner's rights in a health insurance policy?

➡️ Designate/change beneficiaries and make changes without beneficiary consent.

2. When can dependent child benefits not be terminated?

➡️ When the child is incapable of self-support due to a physical or mental handicap.

3. Who receives benefits if the primary beneficiary is deceased?

➡️ The contingent (secondary) beneficiary.

4. What happens if no beneficiary is named?

➡️ Benefits go to the deceased's estate.

5. What does "mode of premium payment" refer to?

➡️ The frequency premiums are paid (monthly, quarterly, etc.).

6. How does payment mode affect cost?

➡️ More frequent payments = higher total premium.

7. What is the purpose of the Coordination of Benefits (COB) provision?

➡️ To avoid duplicate payments and overinsurance

8. What is the primary plan in COB?

➡️ The plan that pays first, providing full specified benefits.

9. What is the secondary plan in COB?

➡️ Pays additional benefits after the primary plan has paid.

10. What is occupational coverage?

➡️ Covers illnesses/injuries that occur on or off the job.

11. What is nonoccupational coverage?

➡️ Covers only illnesses/injuries that occur off the job.

12. What is total disability?

➡️ Inability to perform duties of one's own or any occupation (depends on policy definition).

13. What is partial disability?

➡️ Inability to perform one or more regular duties of one's occupation.

14. What is residual disability?

➡️ Covers loss of income when someone returns to work at reduced capacity after total disability.

15. What is managed care?

➡️ Cost-control system that manages behavior of participants and providers.

16. What is subrogation?

➡️ Insurer seeks reimbursement from a third party responsible for a claim.

17. What are workers compensation eligibility requirements?

➡️ Covered occupation and work-related injury or illness.

18. What benefits are provided by workers compensation?

➡️ Medical, income, death, and rehabilitation benefits.

19. How are personally owned health insurance premiums and benefits taxed?

➡️ Premiums: not deductible;

Benefits: tax-free.