In general, a group health plan that covers employees of an employer that has 101 or more employees. Until 2016, in some states large groups are defined as 51 or more.
- Browse Related Terms: COBRA, COBRA coverage, Employer Choice, Employee Choice, Employer Contribution, Employer or Union Retiree Plans, Flexible Benefits Plan, Fully Insured Job-based Plan, Group Health Plan, Health Reimbursement Account (HRA), Job-based Health Plan, Large Group Health Plan, Medicare Hospital Insurance Tax, Premium, Self-insured, Self-Insured Plan, Small Employer, Third Party Administrator (TPA), Wellness Programs, Worker's compensation
A dollar limit on how much the insurance company will pay in your lifetime. An insurer may, for example, cover up to $1 million over your lifetime. Above this they will pay nothing.
A cap on the total lifetime benefits you may get from your insurance company. An insurance company may impose a total lifetime dollar limit on benefits (like a $1 million lifetime cap) or limits on specific benefits (like a $200,000 lifetime cap on organ transplants or one gastric bypass per lifetime) or a combination of the two. After a lifetime limit is reached, the insurance plan will no longer pay for covered services.
Many health insurance plans have historically placed dollar limits upon the claims that the insurer will pay over the course of an individual's life. The ACA prohibits lifetime limits on benefits beginning for plan years that start on or after September 23, 2010.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
“Limited benefit health insurance policies” can cost far less than traditional insurance, but cap what health insurance carriers will pay toward medical care. For example, the policy may pay $2,500 per person, per year, an amount that would be exhausted by a single trip to the emergency room. Some limited benefit health insurance policies have daily caps, such as paying a few hundred dollars a day toward hospital coverage. This differs from traditional health insurance, which generally covers most medical expenses in a given year, after deductibles and co-payments have been made.
Before purchasing a “limited benefit health insurance policy”, find out if you will be covered for hospital visits or routine doctor’s care and make sure you understand the all of the limits in the benefits provided.
- Browse Related Terms: Access Fee, Catastrophic Health Insurance, Catastrophic Health Plan, Co-insurance, Co-pay, Co-payment, Coinsurance, Cost Sharing, Deductible, Doctor Visits, Limited Benefit Health Insurance Policies, Medicare Supplement (Medigap) Insurance, Out-of-Pocket Costs, Out-of-Pocket Limit, Out-of-Pocket Maximum, Out-of-pocket maximum/limit, Stop-Loss
A type of health plan that provides coverage for only certain specified health care services or treatments or provides coverage for health care services or treatments for a certain amount during a specified period.
- Browse Related Terms: Competitive Bidding, Copayment, Coverage, Health Insurance, In-Network Co-Insurance, In-Network Co-Payment, In-network Coinsurance, In-network Copayment, Limited Benefits Plan, network, Network Plan, Non-preferred provider, Out-of-Network Co-Insurance, Out-of-Network Co-Payment, Out-of-network Coinsurance, Out-of-Network Copayment, Preferred Provider
Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living such as dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living or in nursing homes. Individuals may need long-term supports and services at any age. Medicare and most health insurance plans don’t pay for long-term care.
Long Term Care is the assistance or supervision you may need when you are not able to do some of the basic "activities of daily living" (ADL) like bathing, dressing or moving from a bed to a chair. Examples of conditions in which you might need assistance with ADLs are: injury, illness, advanced age, or mental deterioration.
- Browse Related Terms: Acute Care Facility, Assisted Living, Board and Care Facility (Long Term), Hospice Care, Inpatient Care, Long-term Care, Skilled Nursing Care, Skilled Nursing Facility (SNF), Skilled Nursing Facility Care
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