Insurance claim that must be reviewed because of an unusual, unique, or variation from standard medical service to determine the benefit or payment allowance.
Insurance Encyclopedia
Individual contract
See: individual health plan .
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A contract mad with an individual that covers that individual and perhaps also specified members of his family for benefits as described in the policy.
Individual contract (Health Insurance)
A policy that covers a particular individual and may cover other members of that person’s family.
Individual contract pension trust (Pensions)
A plan wherein the title to insurance or annuity contracts is held by a trust for the policyholders, usually employees.
Individual Declaration basis (Contract Commenced basis)
The cover will be provided only for works actually commenced during the policy period, to be individually declared.Turnover basis : The cover will be provided on the basis of the annual turnover of the contractor from activity of construction works of similar nature. The cover under any of these basis is automatic for any contract work commencing after inception of the policy.Engineering Contract Works (CW) Insurance : CAR + EAR : In practice we come across some special types of contracts in which both the civil engineering work and machinery installation work may be of significant degree. Example, Hydro Electric Project which involves (a) Heavy Civil works like construction of dam, coffer dam, various tunnels, power house building, pen stocks etc., and (b) Installing, testing and commissioning work in respect of machinery like water turbines, electric generator, control room, transformers, switchgear etc. Both the types of work, at certain stages may require to be carried out simultaneously and machinery parts like turbine casing are also to be embedded in civil works. Neither the EAR nor the CAR alone can meet insurance requirements instead if issued separately they may result in gaps and/or overlap in coverage. Thus, a composite policy named Contract Works Insurance Policy combining CAR and EAR is devised. The normal terms and conditions of both CAR and EAR apply to the respective works but policy helps in eliminating any gaps and overlaps in cover. There is another term for Contract Works known as an Open Annual Floater policies for contractors who normally undertake constructions of similar nature in sufficiently large numbers. Effecting a separate CAR policy or EAR policy for each contract becomes administratively cumbersome and inconvenient to handle. Thus, the Annual Floater Cover.
Individual deductible
See: deductible .
Individual employer groups
Name of a segment of the insurance market of single employers that provide insurance coverage for their employees through a master contract that is issued to the employer.
Individual fraud
Type of medical insurance fraud that is committed by individuals on their insurance claims so that they can obtain benefits in excess of their medical expenses. Also see provider fraud and fraud .
Individual funding method
Retirement plan funding system that is determined by first separately calculating the contributions for each of the plan’s participants and then adding those amounts to obtain the total required contribution.
Individual health insurance
See: individual health plan .