Cigna Terms Verified Solutions 2023//2024

Cigna Terms VERIFIED SOLUTIONS 2023//2024 Insurer - ANSWER An entity which provides insurance. Insured - ANSWER A person who buys insurance. Also known as a policyholder or a subscriber. Contract - ANSWER Called the insurance policy. Details conditions and circumstances under which the insurer will compensate he insured. Premium - ANSWER The amount of money charged by the insurer to the insured for coverage. Name the 4 Core Insurance Principles - ANSWER Pooling of Losses, Spread of Risk, Fortuitous Loss, Adverse Selection. Pooling of losses - ANSWER "law of large numbers" The larger the population the easier it is to predict future losses. It helps to create more precise premium rates. Spread of Risk - ANSWER as the group gets bigger the insurer can more accurately predict future losses within a group. Fortuitous Loss - ANSWER a loss that is unforeseen and unexpected. Adverse Selection - ANSWER the social phenomenon where persons with higher than average risk seek greater insurance than those with less risk. Must be mitigated by underwriting. Eligibility - ANSWER describes the employee population that is permitted to elect or decline coverage. Full time= 30+ hours p/w Subscriber - ANSWER The primary policy holder Customers - ANSWER all covered employees and their dependents. Dependents - ANSWER coverage will generally be offered to an employee's legal spouse and dependent children up to the age of 26 (PPACA) Employee Status: Active - ANSWER and subscriber that is currently enrolled in coverage. Employee Status: Waiting periods - ANSWER the period time which must pass before some or all healthcare coverage can begin. ACA says it has to be less than 90 days. Employee Status: Retiree - ANSWER employers may elect to over retirees that are over the age of 65. Less risk because the primary insurer will be medicare. Employee Status: COBRA - ANSWER Employers must offer to temporarily prolong coverage after the employees time with the company ends. Employee will have to pay 100% of the premiums. Packaging: Products - ANSWER Refers to the network of physicians and health care providers that have agreements i