1. Provisions written into the insurance contract denying coverage or limiting the scope of coverage. They may be specific hazards, perils, or conditions. In connection with a preexisting condition, it means that the policy will not pay benefits arising from that condition. 2. Department of Health and Human Services (DHHS) and Office of the Inspector General (OIG) penalty imposed on a provider that prohibits the individual from billing Medicare or other government programs. 3. In the Medicare program, services not covered such as eye examinations, foot care, eyeglasses, hearing aids, cosmetic surgery, custodial care, and personal comfort items. Medical practices are required to make patients aware of their financial responsibility for noncovered services through waiver of liability statements. Also called exceptions .

Insurance agent who works for one insurance company and is not permitted to sell products of other companies. He or she may be salaried or work on a commission basis. Also known as captive agent .

Type of managed health care plan that combines features of HMOs and PPOs. It is referred to as exclusive because it is offered to large employers who agree not to contract with any other plan. EPOs are regulated under state health insurance laws. Such plans are for large clinics to participate in and combine fee-for-service PPO and HMO benefits.
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A plan that requires some or all services to be provided by a very limited number of medical care providers. It is similar to but more restrictive in its provider network than the HMO.

Under the general agency distribution system, a region in which no person other than the general agent is allowed to sell the insurance company’s products.

1. Sole right to render a service or benefit. The provider or group may provide certain services and does not have to share the right with other providers or groups. 2. Clause sometimes found in managed care contracts that prohibits contracting with other plans.

Section in a contract that forbids physicians from contracting with more than one managed care plan (e.g., health maintenance organization, preferred provider organization).

State law in community-property states that lets an insurance company pay proceeds of a life insurance policy in accordance with the terms of that policy without fear of double liability.

Section of an insurance contract that is signed by the insurer indicating that the insurance company has entered into a contract and is bound by its terms.

Person named in a will to carry out the provisions and directions of the will after the death of the testator (person who makes a will).
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The person appointed by the court to carry into effect, or execute, the provisions of a will. The court usually appoints the person named in the will for that purpose, if one is named.

Certain class of employees who are not subject to overtime wages and time limits for work under the Federal Labor Standards Act.
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People who are not employees for the purpose of the Employers’ Liability (Compulsory Insurance) Act 1969. They are: independent contractors; ‘domestic’ employees; people whose employer is related to them (husband, wife, father, mother, grandfather, grandmother, stepfather, son, daughter, grandson, etc); people who are not ordinarily resident in Great Britain and who are working in Great Britain for fewer than 14 days. In the case of offshore installations, people not ordinarily resident in the UK who work on an installation for more than 7 days are not exempt employees.