A policy lapses and is terminated if the insured fails to pay the premium.
For a spending account, this is the date when funds were most recently taken out of your account to pay expenses.
This refers to you or your eligible dependent who enroll for coverage more than 31 days after the eligibility date. Late applicants may be subject to a waiting period.
This refers to an obligation an individual or organization has for a specified amount or action.
This is the maximum amount your plan will pay toward eligible expenses while you're covered under the plan.
Lifetime maximum benefit
This is the total amount a health plan will pay, per covered member, for the lifetime of the coverage.
Lifetime orthodontic services
The maximum amount payable (for each covered person) for eligible charges related to treatment, no further benefits are payable after this maximum is reached.
Limitation and exclusions
Conditions listed in a policy for which benefits are not paid are limitations and exclusions.
Limitations are items or services a health plan does not cover.
The highest amount of money you can be charged for a covered service by doctors and other healthcare suppliers who do not accept Medicare assignment, the limiting charge only applies to certain medical services, not to medical supplies or equipment.
The status of each line item in the claim can be paid, denied, or in process. Each line item may have a different status; however, if the entire claim is pending for review, each line item will indicate “in process.”
If you have a Medicare Advantage and prescription drug plan, you are "locked-in," which means (unless you qualify for special circumstances) you can only switch plans during certain times of the year. The lock-in period runs from April 1 to November 14.
Long-term care hospital
A hospital that has an average inpatient length of stay of greater than 25 days is a long-term care hospital.
These proceeds are paid to beneficiaries all at once instead of in installments.