An insurance applicant who has pre-existing poor health or is in substandard physical condition, is engaged in dangerous activities, or has a hazardous occupation.
The date on which health care services are provided to a covered person. The incurral date, not the date on which the insurance company pays a health care claim, is the critical date in determining health insurance benefits. For example, a health insurance company will not pay a claim for health care services incurred prior to the effective date of the health insurance coverage.
INDEMNITY HEALTH PLAN:
Indemnity health insurance plans are also called “fee-for-service.” These are the types of plans that primarily existed before the rise of HMOs and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the health plan pays the other percentage. For example, an individual might pay 20% for services and the insurance company pays 80%. The fees for services are defined by the health care providers and vary from physician to physician and hospital to hospital.
INDEPENDENT PRACTICE ASSOCIATIONS (IPA):
An IPA is a type of HMO in which care is provided by independent physicians who contract with the HMO. This contrasts with the “staff model” HMO, in physicians are employees of the HMO.
Health care that you get when you stay overnight in a hospital.
A person who has obtained health insurance coverage under a health insurance plan.
INTERNATIONAL CLASSIFICATION OF DISEASES, 9TH REVISION, CLINICAL MODIFICATION (ICD-9-CM):
Coding system maintained by the National Center for Health Statistics and the Center for Medicare and Medicaid Services (CMS). This coding system differentiates diagnostic conditions and is used by hospitals, governments, health insurance plans, and health care providers around the world.