Insurance Terms: COBRA (Consolidated Omnibus Budget Reconciliation Act) - Federal legislation that requires group health plans to provide health plan members the opportunity to purchase continued coverage in the event their insurance is terminated. Cobra generally allows primary plan members to continue coverage for up to 18 months after leaving the job, and secondary plan members for up to 36 months. The total amount of time a person may continue coverage after leaving a job therefore varies.  Cobra applies only to employer groups with 20 or more employees. Co-insurance The percent of each health care bill you must pay out of your own pocket. Non-covered charges and deductibles are in addition to this amount. (The amount you may be required to pay for services after you pay any plan deductibles. Coinsurance percentages add up to 100 percent. Example: If your plan pays 80 percent coinsurance, you pay the remaining 20 percent). Copayments Copayments are amounts you pay each time you go to the doctor, fill a prescription, or receive a covered health service. Deductibles The deductible is the amount that you must pay out of your own pocket for covered expenses during a calendar year before your plan will begins paying co-insurance benefits. Exclusions are expenses which are not covered under an insurance plan. See your policy for details. Grace period(s) The time - usually 31 days - during which a policy remains in force after the premium is due but not paid. The policy lapses as of the day the premium was originally due unless the premium is paid before the end of the 31 days or the insured dies. HIPAA - Health Insurance Portability and Accountability Act of 1996, P.L. 104-91. This law relates to underwriting, pre-existing limitations, guaranteed renewal, COBRA and certification requirements in the event someone terminates from the plan. The new law, commonly known as the "Kennedy-Kassebaum Bill," establishes new requirements for self-funded, fully-insured group plans (including church plans) and Individual Health policies. The purpose of the law is to: -Improve portability and continuity of health insurance coverage in the group and individual markets -To combat waste, fraud and abuse in health insurance and health care delivery -To promote the use of medical savings accounts -To improve access to long-term care services and coverage -To simplify the administration of health insurance   Material misrepresentation A significant misstatement on an application form. If a company had access to the correct information at the time of application, the company might not have agreed to accept the application. Preferred provider organization (PPO)  Hospital, physician, or other provider of health care which an insurer recommends to an insured. A PPO allows insurance companies to negotiate directly with hospitals and physicians for health services at a lower price than would be normally charged. Rated policy  A policy issued at a higher premium to cover a person classified as a greater-than-average risk, usually due to impaired health or a dangerous occupation. Underwriting The process an insurance company uses to decide whether to accept or reject an application for a policy.

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