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
part of the Model Uniform Life and Health Insurance Policy Provisions Law giving an insurer a time limit on contesting coverage for preexisting conditions or misrepresentation. This law, ...
Picture of future dividends that the insurance company expects to be allocated to a specific block of policies. The accuracy of this picture depends on the actual future mortality, ...
Same as term Coinsurance: ...
Coverage for an insured firm if its business debtors fail to pay their obligations. The insured firm can be a manufacturer or a service organization but it cannot sell its products or ...
Mathematical premise stating that the greater the number of exposures, (1) the more accurate the prediction; (2) the less the deviation of the actual losses from the expected losses (X - x ...
Individual action or failure to act as a reasonably prudent person would under similar circumstances, resulting in harm to another. Also called negligence. A reasonably prudent person is ...
A ceding company's premium to which the reinsurance premium factor is used to produce the reinsurance premium. ...
Difference between the actual mortality experience and the expected mortality experience. In statistical terms, this is known as the deviation of the actual (X) from the expected (X). The ...
Time interval between the date benefits end under Social Security and the date these benefits resume. For example, survivor benefits are paid only as long as the parent (if less than age ...
Have a question or comment?
We're here to help.