Term Answer Description A. Consolidated Omnibus Budget Reconciliatiorn Act 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 federal legislation allows an insured group member who leaves the group to retain his or her health insurance coverage, except for disability income coverage, for up to 18 months by paying the premiums to his or her former employer on time 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 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 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 Pre-existing condition clause B. Internal limits C. Surgical expense D. insurance Social Security disability benefits E. Participation clause F. Skilled care G