Insurance provision that restricts coverage regardless of medical necessity. Benefit limitations may be found in the explanation of coverage section of the insurance policy or in a booklet supplied by the insurance company. Also known as benefit booklet, benefit plan summary, summary plan description ; also see explanation of coverage (EOC) .
Insurance Encyclopedia
Benefit maximum
Highest dollar amount that an insurance company or managed care plan will pay for specified health care services. A benefit can be expressed either as a length of time (e.g., 60 days of semiprivate hospital room charges) or as a dollar amount (e.g., $1500 for a certain procedure).
Benefit of Insurance
Term used e.g. in a contract of carriage, where some person such as a bailee stipulated that he shall receive the benefit of insurance effected by the owner.
Benefit of insurance clause
Marine clause meaning that the bailee of goods gets the benefit of any insurance policy effected by the cargo owner should an insured loss occur while the goods are in the bailee’s care. If the contract of carriage is subject to the US Carriage of Goods by Water Act, the clause is void.
Benefit of Salvage
An insurance under a contract of indemnity who pays the value of property lost or destroyed becomes entitled to the salvage.
Benefit of survivorship
Annuity payable to the annuitant for as long as the recipient is alive at the time the payment is due.
Benefit package
Covered medical services a managed care plan or government program offers to individuals or to groups. In addition to physician and hospital services, some insurance policies have coverage for acupuncture, alternative therapies, assisted living care, chiropractic care, dental, drugs, home nursing care, skilled nursing care, and vision care. Also called approved services, benefit plan, benefits , and health benefits package .
Benefit Package, Health
A description of what services the insurer or health plan offers to those covered under the terms of a health insurance contract.
Benefit payment schedule
List of fees, sometimes with procedural code numbers of the services, and description of the services that an insurance plan will pay and are covered under the managed care plan or insurance policy. Also known as schedule of benefits, table of allowances, fee schedule, fee allowance, fee maximum , or capped fee .
Benefit payments
Amounts disbursed for covered services to beneficiaries after the deductible and coinsurance amounts have been deducted.