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.
The Affordable Care Act (ACA) adds important protections related to employment based group health plans that will improve health coverage for you and your family.
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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.
Many of these protections are available now including extending dependent coverage until age 26, prohibiting preexisting condition exclusions for children under 19, and banning lifetime limits on coverage for essential health benefits. This publication does not reflect the provisions of the Affordable Care Act.
For more information, visit the Employee Benefits Security Administration’s ACA Web page at dol.gov/ebsa/healthreform.
You cannot be required to obtain preauthorization from your plan in order for your 48-hour or 96-hour stay to be covered.
A lapse in car insurance coverage means you own a vehicle that no longer has the state-required minimum coverage limits.
The auto insurance industry considers the lapse period to be from the time your coverage stops until: If your insurance company drops you for some reason, you need to get a new policy in place before the old one expires.
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.