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
Same as term : Self Insurance: protecting against loss by setting aside one's own money. This can be done on a mathematical basis by establishing a separate fund into which funds are ...
a large number of homogeneous exposures (in order for the deviation of actual losses from expected losses to approach zero, and thecreditability of the prediction to approach one). loss ...
Property coverage for damage or destruction of structures in the course of construction. For example, the standing frame of a house destroyed by fire would be covered. ...
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 ...
one in which the amount and frequency of payment may fluctuate. ...
Trade group of independent claims adjusters who settle claims for insurance companies on a fee basis. Some insurers use their own staff adjusters to settle a claim. Others use an ...
Entitlement of a participant in an employee benefit insurance plan to receive benefits regardless of his or her employment status. ...
Date at which insurance protection begins. ...
Statutory surplus plus the interest maintenance RESERVE plus the ASSET VALUATION RESERVE. ...
Have a question or comment?
We're here to help.