Chapter 11 Health Insurance Review

These flashcards cover key vocabulary terms and definitions related to Chapter 11 Health Insurance, focusing on concepts of workers' compensation, disability insurance, and related federal programs.

Workers' Compensation

A form of insurance providing wage replacement and medical benefits to employees injured in the course of employment.

No-fault Insurance

Insurance in which benefits are paid regardless of who is to blame for an injury.

Federal Employment Compensation Act (FECA)

An act providing workers' compensation for nonmilitary federal employees.

Longshore and Harbor Workers' Compensation Act

A federal act providing workers' compensation to employees of private maritime employers.

Social Security Disability Insurance (SSDI)

A federal program that provides income to individuals with disabilities who have previously worked a specified amount.

Supplemental Security Income (SSI)

A program providing financial assistance to individuals who are disabled, blind, or elderly with limited income.

Disability Income Insurance

Insurance that replaces a portion of earned income when an individual is unable to work due to non-employment-related injuries.

Vocational Rehabilitation

Services that help individuals with disabilities to gain employment and develop skills.

Claim Filing Process

The procedure an injured employee must follow to file a workers’ compensation claim.

Balance Billing

Practices that are not allowed on workers' compensation claims, where a provider bills a patient for the difference between what the insurance pays and the actual charges.

1800s

Era Worker’s Compensation started 

Companies pay premiums for WC insurance, emplyees agree to

give up the right to sue for job related injuries

WC is considered

Legally Mandated Right

Coming and Going Rule

Exclusion of coverage from most state laws for injuries sustained during employee commuting to and from work.

Ombudsman

Responsible individual who investigates and resolves WC’s complaints against the employer

1st step of Nonemergency on-the-job injury

Employee should notify a supervisor of the accident

Ticket to Work

A program that allows individuals with disabilities to receive employment services while maintaining their Social Security benefits.

medical expenses, disability pay, and death benefits are ex of

workers' compensation insurance benefits.

Eligible Work Credits

Individual must work a specific number of these to qualify for SS benefits

No work requirements for SSI

but the individual needs to establish financial need

Earned Income

refers to the money earned from working wages, which can affect eligibility for various benefits.

Attending Physician Statement

A document completed by a physician that provides details about a patient's medical condition and treatment. Such as physical or mental impairments resulting from work-related incident are determined by this statement

Time Limit

Each State has rules under which an employee is required to file the claim within the limit.

Fraud

Occurs for WC’s claims when false information is provided or circumstances are misrepresented to obtain benefits.

Two Major Disability Coverages

Short-term and Long-term disability

Short Term Disability

Have maximum benefit amount that is paid each month