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 .
Insurance Encyclopedia
Benefit payments
Amounts disbursed for covered services to beneficiaries after the deductible and coinsurance amounts have been deducted.
Benefit period
1. Time period for which benefits are payable under an insurance contract without a new deductible requirement. These effective dates of coverage can be a designated 6-month period, calendar year, or a plan’s anniversary date. Also called spell of illness . 2. Period of time for which payments for Medicare inpatient hospital benefits are available. A benefit period begins the first day an enrollee is given inpatient hospital care (nursing care or rehabilitation services) by a qualified provider and ends when the enrollee has not been an inpatient for 60 consecutive days. Patient must pay the hospital insurance deductible for each benefit period. 3. In workers’ compensation cases, the maximum amount of time that benefits will be paid to the injured or ill person for the disability.
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Commonly disability insurance is has benefit periods of 2 or 5 years, to age 65, or, in some cases, life. Since the chances of becoming disabled are much more for a person 40 years old than the chances of dying and the average length of disability is 3.2 years, the selection of a proper benefit period is important.
Benefit period (Health Insurance)
The time frame in which money or other policy benefits are paid out to either the insured or the insured’s dependents.
Benefit plan
Insurance contract that provides hospital, surgical, medical, or other health coverage; also called benefit contract .
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See: benefit package and certificate of coverage (COC) .
Benefit plan summary
See: benefit limitations .
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See: explanation of coverage (EOC) .
Benefit policy
Policies such as personal accident and life insurances where the amount to be paid is a pre-agreed benefit and is not based on actual losses as with indemnity contracts. Individuals are free to put their own value on life and limb; the main constraint is their ability to pay.
Benefit products
Phrase used by insurance companies and managed care companies that refers to the types of insurance plans they offer; also used as a synonym for benefits .
Benefit provision
Health care service explained in detail that the insurance company agrees to pay to a claimant, assignee, or beneficiary under a health insurance policy or contract.
Benefit schedule
Under a group insurance plan, a table that lists the amount of coverage given to each class of insured and may show earnings and job position. Also known as benefit payment schedule, schedule of benefits, table of allowances, fee schedule, fee allowance, fee maximum , or capped fee .