Individual who earns Social Security credits while working for wages or self-employment income. Also referred to as number holder and worker .

In a workers’ compensation case, the difference between the average weekly wages and the injured worker’s actual earnings while he or she is still temporarily partially disabled but is working at modified work or a reduced work schedule.

In disability insurance, the percentage of the insured’s working wages that a policy will pay, usually 50% to 80% and not 100%.

1. In individual or group health insurance, time between enrollment and the date an individual is eligible for insurance coverage. Usually WPs last from 14 to 30 days after issue of a policy and apply to medical expenses from illness, not from accidents. 2. For a hospital indemnity policy, the time in which benefits may not be paid for the first several days of hospitalization. Elimination periods vary from policy to policy and from company to company. The longer the WP, the lower the cost of insurance. 3. For disability income insurance, the initial period of time when a disabled individual is not eligible to receive benefits even though unable to work. 4. For workers’ compensation, the days that must elapse before workers’ compensation weekly income benefits become payable. Also called eligibility waiting period, elimination period , or probationary period . 5. Time between when an individual signs up with a Medigap insurance company or Medicare health plan and when the coverage starts. 6. In a group health plan, it is the time that must pass before a new employee becomes eligible for plan benefits. The WP usually begins on the date of hire.

1. Agreement attached to an insurance contract eliminating a specific preexisting condition or certain hazard from coverage. Also known as exclusion amendment, endorsement , or rider . 2. Exception to the usual requirements of Medicaid in which state Medicaid agencies must apply and receive permission to provide a service not usually covered by Medicaid.
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US: An agreement attached to a policy which exempts from coverage certain disabilities or injuries that otherwise would be covered by the policy.
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An agreement attached to a policy which exempts from coverage certain disabilities normally covered by the policy.
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Renunciation or abandonment of a right, whereby right is lost, extinguished and may be either expressed or implied. A waiver is an intentional relinquishment of such right. There can be no waiver unless the person against whom the waiver is claimed has full knowledge of his rights and of facts which would enable him to take effectual action for the enforcement of such rights. No one can acquiesce in a wrong while ignorant that it has been committed and the effect of his action will be to confirm it.

Provision in a health insurance policy in which the insured does not have to pay the initial deductible if medical expenses result from an accidental injury.

1. Provision of the Social Security Act, Sections 1842(1) and 1879, that protects the patient from financial liability when Medicare denies or reduces payment for a service or item based on it being considered as ‘not reasonable and necessary’; under this provision, the patient may not be required to pay the provider for a service, if certain conditions are met. 2. In the Medicare program, provision that a beneficiary is not responsible to pay for a medical service if he or she was not informed that the service would not be covered by Medicare. Also see Advance Beneficiary Notice (ABN) .

1. Provision in an insurance policy that states under certain situations the insured’s coverage will continue without further payment of premiums (e.g., occurrence of permanent or total disability or unable to work due to an accident or injury). 2. Disability insurance policy provision that an employee does not have to pay any premiums while disabled. Also known as elimination period or waiver of premium for disability benefit .