A group life and/or pension scheme that varies the benefits for members according to categories of membership. Life cover for one category might be three times income, but four times for another. Each category is carefully defined in order to ensure that there is no discrimination against individuals.
Insurance Encyclopedia
Benefit booklet
See: benefit limitations and explanation of coverage (EOC) .
Benefit contract
See: benefit plan .
Benefit days
1. Total number of days that an insurance company will pay within a benefit period. 2. Under the Medicare program, the number of days that a beneficiary is entitled to receive payment for covered services with the exception of lifetime reserve days. Also see lifetime reserve .
Benefit Duration
The maximum period during which disability income benefits are payable.
Benefit exhausted date
Medicare phrase that refers to the date on which the beneficiary has used the maximum benefits for a current benefit period. This applies when a patient refuses to use or has used all of his or her lifetime reserve days. Under the Medicare program, a reserve of 60 days of inpatient hospital care is available over an individual’s lifetime beyond the normal limit. Also see lifetime reserve .
Benefit formula
Method for establishing the amount of benefit payable under each contingency (unforeseen event) covered by a group insurance contract. The formula includes salary and job or years of employment at the time the benefit is paid.
Benefit formula (Health Insurance)
A way of calculating the amount of benefits the insured is entitled to, under an employee benefit plan.
Benefit levels
1. Limit of benefits an individual is entitled to receive depending on the insurance policy. 2. In workers’ compensation cases, benefit levels for an injured employee are set by state laws.
Benefit Levels, Health
The maximum amount a person is entitled to receive for a particular service or services as spelled out in the contract with a health plan or insurer.