LOMA 280 Questions and Answers 100%
Solved
Retrospective Review Same as preadmission but is done after the patient's release
from hospital. This is a concurrent review step of the whole analysis. This might reveal
erroneous charges and billing errors.
Concurrent Review While patient is in hospital, UR staffs monitors the condition
Disability income insurance policies typically specify that income benefits will not be paid to a
disabled insured if the insured's disability is The result of the insured's active participation
in a riot
Premium delay arrangement This allows the group policyholder to postpone paying
monthly group insurance
premium for a stated period of time (usually 60 or 90 days) beyond the expiration
of the policy's grace period.
,Retrospective rating arrangemen he insurer agrees to charge the group policyholder a
lower monthly
premium than it would normally charge based upon the group's prior claim
experience. On the other hand, the Group Policy Holder agrees to pay an
additional amount to the insurer if at the end the policy year; the group's claim
experience becomes unfavorable
Stop-loss coverage arrangement If a self-insured group experiences several catastrophic
medical claims in one
year, the employer may not have that much fund to cover all such claims. To deal
with such situations many employers purchase Stop-Loss Insurance from an
Principles of Insurance: Life, Health & Annuities Page 96 of 110
Dated: 26th Feb, 2003
insurance co. so that they can transfer their liability to the insurance co. when the
claims exceed a certain dollar amount.
Minimum premium plan (MPP) Under MPP, the group policyholder deposits into a
special account funds an
amount that is sufficient to pay a stated amount of claims. The insurer pays the
, claims until this fund is exhausted. Thereafter, the insurer is responsible for
paying the claims from its own fund against a very nominal premium from the
group policyholder. In MPP the premium taxes get considerably reduced.
physical examination provision After the insured submits a claim, the insurer has the right
to have the insured examined
by a doctor of the insurer's choice, at the insurer's expense
Salary Continuation Plan a type of self-insured disability income plan typically provides
100% of the insured employee's salary, beginning on the first day of the employee's absence due
to sickness or injury and continuing for some specified time
Commutative contract Plan
Guaranty Association Plan
Business Continuation Insurance Plan an insurance plan designed
to enable a business owner (or owners) to continue business operation if
Solved
Retrospective Review Same as preadmission but is done after the patient's release
from hospital. This is a concurrent review step of the whole analysis. This might reveal
erroneous charges and billing errors.
Concurrent Review While patient is in hospital, UR staffs monitors the condition
Disability income insurance policies typically specify that income benefits will not be paid to a
disabled insured if the insured's disability is The result of the insured's active participation
in a riot
Premium delay arrangement This allows the group policyholder to postpone paying
monthly group insurance
premium for a stated period of time (usually 60 or 90 days) beyond the expiration
of the policy's grace period.
,Retrospective rating arrangemen he insurer agrees to charge the group policyholder a
lower monthly
premium than it would normally charge based upon the group's prior claim
experience. On the other hand, the Group Policy Holder agrees to pay an
additional amount to the insurer if at the end the policy year; the group's claim
experience becomes unfavorable
Stop-loss coverage arrangement If a self-insured group experiences several catastrophic
medical claims in one
year, the employer may not have that much fund to cover all such claims. To deal
with such situations many employers purchase Stop-Loss Insurance from an
Principles of Insurance: Life, Health & Annuities Page 96 of 110
Dated: 26th Feb, 2003
insurance co. so that they can transfer their liability to the insurance co. when the
claims exceed a certain dollar amount.
Minimum premium plan (MPP) Under MPP, the group policyholder deposits into a
special account funds an
amount that is sufficient to pay a stated amount of claims. The insurer pays the
, claims until this fund is exhausted. Thereafter, the insurer is responsible for
paying the claims from its own fund against a very nominal premium from the
group policyholder. In MPP the premium taxes get considerably reduced.
physical examination provision After the insured submits a claim, the insurer has the right
to have the insured examined
by a doctor of the insurer's choice, at the insurer's expense
Salary Continuation Plan a type of self-insured disability income plan typically provides
100% of the insured employee's salary, beginning on the first day of the employee's absence due
to sickness or injury and continuing for some specified time
Commutative contract Plan
Guaranty Association Plan
Business Continuation Insurance Plan an insurance plan designed
to enable a business owner (or owners) to continue business operation if
