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This chapter turns to the various classes of health insurance policies and the concepts that apply broadly across health coverage. You'll begin with the principal types of losses and benefits covered, common exclusions, and a producer's responsibilities and liabilities for errors made along the way. From there, the chapter takes a close look at health insurance underwriting — a process that is especially vulnerable to unfair discrimination because of the sensitivity of health conditions and genetic information. The chapter closes with the components that go into setting health insurance rates, and the respective duties of the insured and the insurer when a loss occurs.
| Term | Definition |
|---|---|
| Comprehensive coverage | Health insurance that provides coverage for most types of medical expenses |
| Copayment | An arrangement in which an insured must pay a specified amount for services "up front," with the provider paying the remainder of the cost |
| Deductible | The portion of a loss that is to be paid by the insured before any claim may be paid by the insurer |
| Dependent | Someone relying on the insured for support |
| Enrollee | A person enrolled in a health insurance plan — an insured (does not include the insured's dependents) |
| Insolvent | Unable to meet financial obligations |
| Pre-existing conditions | Conditions for which the insured has received diagnosis, advice, care, or treatment during a specific time period prior to the application for health coverage |
| Riders | Provisions added to a basic insurance policy to add, modify, or delete policy provisions |
| Solicitation | An attempt to persuade a person to buy an insurance policy; may be done orally or in writing |
| Waiting period | A period of time that must pass after a loss occurs before the insurer starts paying policy benefits |
Terms to Know