If your employer or your spouse’s employer offers a health plan, birth, adoption, and placement for adoption may also trigger a special enrollment opportunity for you, your spouse, and your child, without regard to any open season for enrollment.
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Example: Claim for date of service 12/1/15 was denied on 1/10/16 due to member having primary coverage effective 1/1/15, and the EOB was not attached to the claim.
Specialists document the referral in the member's chart as well. For more information, please visit the Referrals and Prior Authorizations section of the Provider Manual.
Aggregate: The maximum amount an insurance company will pay during the policy All Risk Coverage: Property insurance covering loss arising from all causes of loss except those that are specifically excluded Annually Renewable Term: Term insurance that provides coverage for one year and allows the policy owner to renew his or her coverage each year.
Application: A form with the information needed for an insurance company to underwrite and rate a specific policy Assignment Assignment: The transfer of ownership of a Life Insurance policy from one person to another. Your attained age is a factors life insurance companies use to determine premiums.
But before your insurance company can end your coverage, you have a short period of time to pay called a “grace period.” The health insurance grace period is usually 90 days — if both of the following are true: Note: If you don’t qualify for a premium tax credit, your grace period may be different.
Contact your State Department of Insurance for information on grace periods in your state.If a group health plan, health insurance company, or health maintenance organization (HMO) provides maternity benefits, it may not restrict benefits for a hospital stay in connection with childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section.You cannot be required to obtain preauthorization from your plan in order for your 48-hour or 96-hour stay to be covered.Audit: A verification of the financial records, usually payroll or receipts, of an organization to determine exposures and premiums Automobile: A land motor vehicle, trailer or semi-trailer designed for travel on public roads, not including 'mobile equipment' Backdating: Making the effective date of a policy earlier than the date of application. Best Company giving the financial condition of insurance companies Binder: A temporary insurance policy that expires at the end of a specific time period or when a permanent policy is written.Backdating is often used to make the age of the applicant lower than it actually was at the time of application so that he/she can get a lower premium. Bailee Coverage: Coverage on property left in the care of the insured for storage, repair or servicing Basic Cause of Loss Form: Property coverage for named perils: Fire, Lightening, Explosion, Smoke, Windstorm, Hail, Riot, Civil Commotion, Aircraft, Vehicles, Vandalism, Sprinkler Leakage, Sinkhold Collapse and Volcanic Action Basic Limits: The minimum limits of liability that can be carried by an insured Beneficiary: The designated person set to receive the death benefit if the insured should die. A binder is given to an applicant for insurance during the time it takes the an insurance company to complete the policy paperwork.A lapse in car insurance coverage means you own a vehicle that no longer has the state-required minimum coverage limits.