MEDICAL,USA: 1. Health care service that the insurance company agrees to pay to a claimant, assignee, or beneficiary under a health insurance policy or contract. 2. Amount of money an insurance company (payer) will pay for the medical care and services. See covered expenses or coverage . Also called the policy benefit .
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An amount paid to a beneficiary of an insurance policy, or the participant of a retirement plan.
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UK: an amount payable by an insurer as a consequence of liabilities assumed under an insurance contract.
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UK: Describes the amount to be paid upon the happening of the insured event. The benefit is agreed at the inception of the contract and, not being based on actual losses, is not subject to the principle of indemnity. See BENEFIT POLICY.
Insurance Encyclopedia
Benefit allocation method (Pensions)
A method of funding a pension. Only one premium payment is made per year and used to purchase a single benefit. This is done for each year of service to the employer. Usually, an annuity is purchased.
Benefit basis
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.
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.