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
Coverage for the employer in the event of a tort committed by an employee in the use of his or her own car while conducting business on behalf of the employer. ...
Frequency and severity of accidents resulting from conditions and environment surrounding one's workplace. Occupation is an important underwriting factor when considering an applicant for ...
Financial analysis method established by the national association of insurance commissioners (naic) to detect problems of property and casualty insurance companies and life and health ...
Coverage in which an initial premium is charged, with the stipulation that an additional premium can be charged later if the loss experience of the insurance company warrants it; that is, ...
Workers' premiums in a contributory employee benefit plan. ...
Requirement that the combination of medicare and the employer's plan can not be greater than the amount the employer's plan would pay without Medicare. ...
Plans that are similar to stock appreciation rights (SARS) in that an employee is granted a contractual right by the employer to a stipulated number of units in the business, which is ...
Coverage for bodily injury and/or death resulting from accidental means (other than natural causes). For example, an insured is critically injured in an accident. Accident insurance can ...
Agreement concerning an insured individual, not the insured's property. A property and casualty insurance contract cannot be assigned, since it follows the insured, not the property. For ...
Have a question or comment?
We're here to help.