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Active Work Requirement

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The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.

Beneficiary

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The person who is getting a benefit.

Coverage Effective Date

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The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.

Group Coverage

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Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.

Initial Enrollment Period (Private Coverage)

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The first time an individual is eligible to enroll in a group’s benefits programs.

Medical Treatment/Care

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Any medical care that you receive for a medical condition. Some examples include being prescribed medication, visits to the doctor, and therapy for a mental health problem.

Medical Underwriting

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The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Open Enrollment Period

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The annual time period when an individual may add or change private insurance plans offered by an employer, an association, or through Covered California. Certain situations, such as divorce, the birth of a child, or loss of another insurance plan may allow a person to sign up for an insurance plan outside of this time period.

Pre-Existing Condition

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Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

Premium (General)

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A regularly scheduled payment to an insurer or health care plan.

Service Wait

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The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirement.

Surrender Value

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If you were to cancel a life insurance policy prior to death or maturity, you would likely receive some portion of the full value of that policy. The amount you would receive is known as the “surrender value.” The surrender value of your policy should be written into it. If you do not know the surrender value, contact your policy administrator to find out. Not all policies have a surrender value (i.e. - burial insurance and many term insurance policies).