Termination of an insurance policy or bond by an insurance company or a policyholder before its expiration date.
A compensation plan used in some health maintenance organizations (HMOs) in which a physician is paid a flat amount per year per subscriber who elected to use that physician. For that amount, the physician must treat the subscriber as often as necessary during that year. Physicians are not reimbursed for services that exceed the allotted amount.
Captive agent
An agent who sells insurance for only one company, as opposed to an independent agent who represents several companies.
Care coordination
Services provided by a licensed or certified health care professional designated by the insurance company to perform an assessment and develop a plan to meet your long-term care needs.
Caregiver training
Training provided in order to assist an informal and unpaid caregiver to care for you at home.
An insurance company that actually underwrites and issues the insurance policy. The term is used because the insurance company assumes or carries the risk for policyowners.
Case management
A process by which an enrollee with a serious, complicated, or chronic health condition is identified by a managed care organization and a plan of treatment is established in order to achieve optimum health in a cost-effective manner.
Cash value
In a life insurance policy, the amount of money, before adjustment for factors such as policy loans or late premiums, that the policy owner will receive if the policy owner allows the policy to lapse or cancels the coverage and surrenders the policy to the insurance company. Cash values are a feature of most types of permanent life insurance, such as whole life and universal life.
Centers for Medicare & Medicaid Services (CMS)
The federal agency that runs the Medicare program.
Certificate of insurance
The formal document received by an employee that describes the specific benefits covered by the policyholder's group health care contract with the insurance company. The certificate contains copayment and/or deductible requirements, specific coverage details, exclusions and the responsibilities of both the certificate holder and the insurance company.
A request by an insured for payment under the terms of an insurance policy.
The person or party making a formal request for payment of benefits due under the terms of an insurance contract.
The grouping, for underwriting, rating or other purposes, of policyholders or properties having the same general characteristics. Your insurance rate would be changed if you were reclassified.
Closed panel
A type of health plan that requires enrollees to seek care from a medical provider who is either employed by or under contract to the health maintenance organization or limited service health organization.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)
The federal law that requires companies with 20 or more employees to offer separating employees the option to continue their group health-care coverage at their own expense.
Cognitive impairment
A deficiency in your short-term or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.
A provision in insurance policies that requires the insured to share in the cost of covered services on a percentage basis. A typical coinsurance arrangement is 80% by the insurer and 20% by the insured.
An optional auto insurance coverage that pays for damage to the policyholder's car caused by its collision with another vehicle or object.
Community Based Residential Facility (CBRF)
These facilities are licensed, registered, or certified by the Department of Health and Family Services (DHFS). CBRFs are covered only if your policy identifies these facilities as a covered benefit and the facility has been licensed as a CBRF by DHFS.
Comprehensive coverage or other than collision
An optional auto insurance coverage that pays for damage to the policyholder's car for losses caused by fire, theft, vandalism, falling objects and various other perils. Damage from striking a deer is a relatively frequent accident in Wisconsin. Most policies cover hitting an animal under comprehensive, not collision, insurance.
Provisions of an insurance policy that state the rights and duties of the insured or the insurance company. Typical conditions have to do with such things as the insured's duties in the event of loss, cancellation provisions, and the rights of the insurer.
Contingent nonforfeiture or contingent benefit upon lapse
In a long-term care insurance policy, if you reject the mandatory offer of a nonforfeiture benefit, the insurance company must provide a "contingent benefit upon lapse." This means that when the premiums increase to a certain level (based on a table of increase provided to you in the policy information), the benefit will take effect. You will then be offered, within 120 days of the due date of the new premium, the opportunity to accept one of the following options: 1) reduce your benefits provided by the current policy so that your premium will stay the same, or 2) convert your policy to a paid-up status with a shorter benefit period.
The formal legal document, also known as the "policy" that describes the agreement between the policyholder and the insurance company. This document contains the specific responsibilities of the policyholder and the insurance company in relation to the benefits provided under the contract.
Coordinated care plan
Any form of Medicare Advantage plan that relies on a provider network to deliver care to enrollees, including HMOs and other managed care plans. Most coordinated care plans will make you pay for all or part of the cost of using a provider who is not part of their network.
Coordination of benefits (COB) clause
A provision in a group health insurance policy that applies when a person is covered under more than one group medical program. It requires the payment of benefits to be coordinated by all insurance companies who cover that person in order to eliminate overinsurance or duplication of benefits.
A provision in insurance policies that requires the insured to pay a flat fee for certain medical expenses.
Services that meet the plan requirements for reimbursement. A medical service is not necessarily covered, even if your health care provider says you need it, unless the service meets the terms of the health plan.
Creditable coverage
Previous health coverage that reduces the time you have to wait before preexisting health conditions are covered by a policy you buy during your Medigap open enrollment period.
Custodial care
The level of care required to assist an individual in the activities of daily living. This care helps meet personal needs and can be provided by persons without professional licenses or extensive training.

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