Contractual benefits that are based on the actual amount of financial loss. In traditional medical expense insurance plans, insureds are reimbursed for the covered medical expenses they incur up to a maximum dollar amount. Also known as reimbursement benefits. TO TOP
Compensation paid to the workers' compensation claimants for non-medical loss resulting from an injury or illness. Six types of award are permitted by the WCL: • temporary total disability benefits (for periods of total wage loss); • temporary partial disability benefits (for periods of partial wage loss); • facial disfigurement awards (at judge's discretion but subject to a maximum, for cosmetic facial disfigurement resulting from the accident or exposure); • permanent partial disability benefits (for loss if physical function or for periods of partial wage loss after a claimant has been classified as having a permanent partial disability); • permanent total disability benefits (for loss of wage earning capacity after a claimant has been classified as having a permanent total disability); and • death benefits (compensation benefits awarded to spouse, children or under certain circumstances, other family members following a work-related death).
Established dollar allowances for covered services. Payments are made toward the charge, not necessarily as payment in full.
Benefits for which the insurance company payment is a fixed dollar amount.
A type of health insurance product characterized by reimbursement on a fee for service basis, freedom of choice in selecting providers and fewer managed care rules and regulations.
Insurance benefits based on payment of a defined amount of money for a specified range of covered services, usually incorporating maximum limits.
Compensation paid to the Workers' Compensation claimants for lost time resulting from an injury or illness.
Benefits in the form of cash payments rather than services. In most cases, after the provider of service has billed the patient, the insured person is reimbursed by the company.
Cash benefits paid to an injured worker to replace part of wages lost as a result of a work injury.
Medical expense insurance plan benefits that are stated as a specified maximum dollar amount that will be reimbursed for each covered service. Also known as reimbursement benefits. Contrast with service benefits. Most commercial insurers previously provided indemnity benefits but many now provide service benefits.