Term Answer Description A. Consolidated Omnibus Budget Reconciliation Act This type of insurance covers the cost of surgery in or out of a hospital, and may cover the costs of anesthesia, a limited allowance for diagnostic tests, and non-emergency treatment using imaging Pre-existing B. This method of controlling costs requires that a second surgeon provide an opinion on the need for and nature of a non-emergency surgical operation This is a practice used by individuals, employers or other groups to fully or partially cover the health care costs of themselves, their employees or their members This component of most health insurance policies limits the amount that will be paid for certain specified expenses-even if the claim does not exceed the overall policy limits These benefits will be received (1) only if you are 100% disabled, (2) your disability is expected to last at least one year or to be fatal, and (3) only after a five-month waiting period This provision in many health insurance policy requires the insurer to pay some portion of the amount of the covered loss in excess of the deductible condition clause Internal limits C. Surgical expense D. insurance E. Social Security disability benefits Participation F. clause Skilled care G. Prior to the Affordable Health Care Act, this clause was included in many insurance contracts and allowed an insurer to permanently or temporarily exclude coverage for any physical or mental condition the insured had at the time the policy was purchased This type of care is needed when a patient requires constant attention from a medical professional, such as a doctor or registered nurse Community rating approach H. Self insurance I. This federal legislation allows a retiree and his or her family to retairn access to their group health insurance coverage, except for disability income coverage, for up to 18 months or until they become eligible for Medicare, whichever occurs first. Second surgical opinion In its pure form, this method of determining insurance premiums charges the same premium to all members of a community, and ignores the personal health, age, gender or other relevant factors when assessing the price of an individual's insurance coverage