Exclusions, Medical Benefits
Definition of "Exclusions, medical benefits"
Limiting provision. Exclusions listed in group health plans include: benefits under Workers Compensation; certain dental procedures; convalescent or rest cures; medical expenses resulting from the insured person and/or covered dependents committing a felony or misdemeanor; cosmetic surgery, unless required immediately because of non-occupational disease, illness, accident, injury, or congenital anomaly in an insured newborn infant; expenses incurred by a member of a health maintenance organization (HMO) or other prepaid medical plan; expenses associated with intentional self-inflicted injuries or attempt at suicide; unreasonable charges for services or supplies; convenience items such as telephone and television.
Popular Insurance Terms
Means of projecting the costs of pension plans on a level basis over a specified future period of time. The actuarial value of each employee's future benefits to be paid at retirement is ...
Provision in ocean marine cargo policies to limit an insurance company's liability for partial losses; the company has liability only for losses that exceed a stipulated percentage of the ...
Coverage for furs owned by a furrier, or a customer's furs in the care, custody, and control of the furrier. Coverage is on an all risks basis except those specifically excluded: wear and ...
Actual morbidity experience of an insured group as compared to the expected morbidity for that group. ...
Charitable planning strategy in which a donor sells an asset to the charity for an amount less than its fair market value. Internal Revenue Service regulations require that the tax basis ...
Arrangement under which employees may choose their own employee benefit structure. For example, one employee may wish to emphasize health care and thus would select a more comprehensive ...
Insurance that covers an indirect loss stemming from a direct loss by a covered peril to income-producing property. A building destroyed by fire represents a direct loss. Lost income ...
Health plan that pays a flat fee for each patient it covers. ...
Process of distributing the costs associated with losses and risks over a number of insureds. ...
Have a question or comment?
We're here to help.