Accident and Health Insurance
Definitions and benefit design
Health insurance pays for sickness and injury; accident-only policies pay for accidental means. Disability income replaces a portion of earned income, typically 50–70%, and is framed by the benefit period, the elimination period, and the definition of disability: own occupation for a limited period (often two years), then any occupation. Residual disability pays in proportion to lost income; partial disability pays a reduced flat amount; presumptive disability pays full benefits for loss of sight, hearing, speech, or two limbs.
Renewability and cost sharing
Cancellable policies may be cancelled and rates raised; optionally renewable ones renew at the insurer's option; conditionally renewable ones renew unless stated conditions apply; guaranteed renewable policies can raise rates only for an entire class, not an individual; noncancellable policies guarantee both renewal and premium. Cost sharing includes deductibles, coinsurance, copays, and out-of-pocket maximums.
Coordination and regulation
Coordination of benefits makes the active employee plan primary over COBRA or retiree plans; for dependent children the birthday rule gives primacy to the parent whose birthday falls earlier in the year. HIPAA governs portability and privacy; the ACA requires guaranteed issue, essential health benefits, preventive services without cost sharing, dependent coverage to age 26, and no annual or lifetime dollar limits. COBRA provides continuation coverage, and Medicare Parts A through D plus Medigap cover the senior market.
Trap watch
The elimination period is measured in time, not dollars, and it restarts after a recurrence within the stated window. A preexisting-condition clause is a temporary limit on benefits measured by a look-back period, not an automatic lifetime exclusion.
Rule of thumb
Match the definition to the price: own-occupation coverage is the richest and most expensive, so exam items usually pair it with a two-year limit.