health insurance product codesia.ldi.state.la.us/.../r78web4-healthprods-intro.pdfhealth maintenance...

Health Maintenance Organization plans for all individual and group policyholder types

Excess / Stop-Loss Insurance Products

All types of Excess / Stop-Loss Insurance Products falling under definition of Health & Accident Insurance

Blanket Group Plans

Blanket Group plans for Limited Benefit coverage only

Health Maintenance Organization

Long Term Care

Long Term Care insurance for all individual and group policyholder types

Major Medical plans for all individual and group policyholder contract types (including Blanket Group)

Limited Benefit Plans

Limited Benefit plans for all individual and group policyholder contract types (except Blanket group)

Primary Types of Health Insurance

Explains the primary coverage types and primary policyholder types for health insurance products

Major Medical Plans

HEALTH INSURANCE PRODUCT CODES

Insurance of human beings against bodily injury, disablement, or death by accidental means. Benefits are provided in the form of cash payments rather than services. H-Ind

PRIMARY SUBTYPES:MAJOR MEDICAL - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services. Hospital Surgical Medical Expense Plans offer limited benefits for out-patient services.

LIMITED BENEFIT PLANS - Insurance providing benefits for diagnosis and treatment of specifically named health related perils. Benefits may be paid as expense incurred, per diem, or a principle sum. Also includes Medicare supplement and select plans, designed to help fill the "gaps" in protections granted by the federal Medicare program.

LONG TERM CARE - Insurance providing coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Also includes Nursing Home and Home Health Care policies.

Health Maintenance Organizations provide or arrange for the provision of basic and other health care services through a network of medical providers to enrollees residing within a defined service area in return for a prepaid charge, negotiated rate or discounted fee.

H-Hmo

Health and Accident insurance covering the losses of an insured above a specific amount or a self-insurer for losses over a stated amount. H-ESL

Association Group for Individual Members

Group health and accident insurance issued to an organization that has been legally formed and is being maintained under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to one or more individual members, with or without eligible dependents.

H-Ind01

PRIMARY TYPES OF HEALTH INSURANCE POLICYHOLDERS

Health Maintenance Organization

Excess Stop-Loss

PRIMARY TYPES OF HEALTH INSURANCE

Health & Accident Indemnity

Individual Family Group

Individual policies of health and accident insurance covering any one person, with or without any eligible family members including spouse, unmarried children under 21 years of age, and grandchildren who are in the legal custody of and residing with the grandparent under 21 years of age or, in the case of full-time students, unmarried children and grandchildren under the age of 24.

H-Ind02

Association Group for Employer Members

Group health and accident insurance issued to an organization that has been actively in existence for at least five years, legally formed and maintained in good faith under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to the employees of one or more member employers. Membership may not be conditioned upon any health status-related factor, coverage must be available to all employees and other individuals eligible for coverage through a member employer, and coverage may not be available other than in connection with a member employer.

H-Ind03

Multiple Employer Trust

Group health and accident insurance issued to the trustees of a fund established by two or more employers in the same industry, by one or more labor unions, or by a bona-fide association of employer members to insure employees and members with or without any eligible family members.

H-Ind04

Single Employer Group Group health and accident insurance issued to a single employer to insure employees with or without any eligible family members. H-Ind05

Blanket Group Plans Health and Accident Insurance issued to special groups of persons. H-Ind07

Association Group for Individual Members

HMO coverage issued to an organization that has been legally formed and is being maintained under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to one or more individual members with or without eligible dependents.

H-Hmo01


HMO coverage issued to any one person, with or without any eligible family members including spouse, unmarried children under 21 years of age, and grandchildren who are in the legal custody of and residing with the grandparent under 21 years of age or, in the case of full-time students, unmarried children and grandchildren under the age of 24.

H-Hmo02

Association Group for Employer Members

Group HMO coverage issued to an organization that has been actively in existence for at least five years, legally formed and maintained in good faith under a constitution and by-laws for purposes other than the procurement of insurance, providing coverage to the employees of one or more member employers. Membership may not be conditioned upon any health status-related factor, coverage must be available to all employees and other individuals eligible for coverage through a member employer, and coverage may not be available other than in connection with a member employer.

H-Hmo03

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Multiple Employer Trust

HMO Plan issued to the trustees of a fund established by two or more employers in the same industry or by one or more labor unions to insure employees or members with or without any eligible family members.

H-Hmo04

Single Employer Group HMO Plan issued to a single employer to insure employees with or without any eligible family members. H-Hmo05

Excess Stop Loss / Self-Funded Employer

Excess or Stop-Loss insurance intended for issue to cover losses of an employer sponsored, self-funded group health plan. H-ESL01

Excess Stop Loss / Self-Ins Plan

Group Excess or Stop-Loss insurance issued to a self-insurer authorized to make, provide or issue a self-insurance plan in Louisiana, including both aggregate and specific coverage and provisions to cover incurred, unpaid claims liability in the event of plan termination or insolvency.

H-ESL02

Excess Stop Loss / Provider -Managed Care

Excess or Stop-Loss insurance intended for issue to protect health care providers from a portion of the financial risk assumed in managed care contracts. H-ESL03

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Policyholder Types PRODUCT NAMES MAJOR MEDICAL PRODUCT DESCRIPTIONS LA DOI Product

Codes

Major MedicalMajor Medical Plan issued to Individual Members of an Association - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services.

H-Ind01.MM-01

Major Medical / PPO

Major Medical PPO Plan issued to Individual Members of an Association - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind01.MM-02

Major Medical / POS Major Medical POS Plan issued to Individual Members of an Assn - Includes the option of seeking covered services at the point-of-service. H-Ind01.MM-03

Hospital Surgical Medical Expense

Hospital Surgical and Medical Expense Plan issued to Individual Members of an Assn - Insurance coverage of hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services.

H-Ind01.MM-04

Hospital Surgical Medical Expense / PPO

Hospital Surgical and Medical Expense PPO Plan issued to Individual Members of an Assn - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind01.MM-05

Hospital Surgical Medical Expense / POS

Hospital Surgical and Medical Expense POS Plan issued to Individual Members of an Assn - Includes the option of seeking covered services at the point-of-service.

H-Ind01.MM-06

Major MedicalMajor Medical Plan issued to an Individual Family Group - Insurance coverage of hospital, surgical and medical expenses for both in-patient and out-patient services.

H-Ind02.MM-01

Major Medical / PPO

Major Medical PPO Plan issued to an Individual Family Group - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind02.MM-02

Major Medical / POS Major Medical POS Plan issued to an Individual Family Group - Includes the option of seeking covered services at the point-of-service. H-Ind02.MM-03


Hospital Surgical Medical Expense Plan issued to an Individual Family Group - Insurance coverage of hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services.

H-Ind02.MM-04

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Hospital Surgical Medical Expense / PPO

Hospital Surgical Medical Expense PPO Plan issued to an Individual Family Group - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind02.MM-05

Hospital Surgical Medical Expense / POS

Hospital Surgical Medical Expense POS Plan issued to an Individual Family Group - Includes the option of seeking covered services at the point-of-service.

H-Ind02.MM-06

ConversionMajor Medical or Hospital Surgical Medical Expense Plan issued to an Individual Family Group under a guaranteed issue right to convert from group health and accident insurance coverage for specified reasons.

H-Ind02.MM-07

Short Term Health Plan

Major Medical or Hospital Surgical Medical Expense Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.

H-Ind02.ST

Short Term Major Medical

Major Medical Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.

H-Ind02.ST-01

Short Term Hospital Surgical Medical Expense

Hospital Surgical Medical Expense Plan issued to an Individual Family Group for a period of no more than six months. The policy is generally designed to provide insurance during a "gap" in coverage and is not renewable.

H-Ind02.ST-02

Major Medical / Any Size Group

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. H-Ind03.MM-01

Major Medical / Small Group Only

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees. H-Ind03.MM-01A

Major Medical / Large Group Only

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. H-Ind03.MM-01B

Major Medical / PPO - Any Size Group

Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-02

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Major Medical / PPO - Small Group Only

Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-02A

Major Medical / PPO - Large Group Only

Major Medical PPO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-02B

Major Medical / POS - Any Size Group

Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-03

Major Medical / POS - Small Group Only

Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-03A

Major Medical / POS - Large Group Only

Major Medical POS Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-03B

Major Medical / High Deductible Reimbursement Acct - Any Size Grp

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind03.MM-04

Major Medical / High Deductible Reimbursement Acct - Small Group Only

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind03.MM-04A

Major Medical / High Deductible Reimbursement Acct - Large Group Only

Major Medical Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind03.MM-04B

Hospital Surgical Medical Expense / Any Size Group

Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ any number of employees. H-Ind03.MM-05

Hospital Surgical Medical Expense / Small Group Only

Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees.

H-Ind03.MM-05A

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CodesHospital Surgical Medical Expense / Large Group Only

Hospital Surgical Medical Expense Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees. H-Ind03.MM-05B

Hospital Surgical Medical Expense / PPO - Any Size Group

Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-06

Hospital Surgical Medical Expense / PPO - Small Group Only

Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-06A

Hospital Surgical Medical Expense / PPO - Large Group Only

Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind03.MM-06B

Hospital Surgical Medical Expense / POS - Any Size Group

Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-07

Hospital Surgical Medical Expense / POS - Small Group Only

Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-07A

Hospital Surgical Medical Expense / POS - Large Group Only

Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind03.MM-07B


Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. H-Ind04.MM-01

Major Medical / Small Group Only

Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees. H-Ind04.MM-01A


Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. H-Ind04.MM-01B

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Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-02


Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-02A


Major Medical PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-02B


Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-03


Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-03A


Major Medical POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-03B


Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind04.MM-04


Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind04.MM-04A


Major Medical Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind04.MM-04B

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CodesHospital Surgical Medical Expense / Any Size Group

Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees. H-Ind04.MM-05


Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees.

H-Ind04.MM-05A

Hospital Surgical Medical Expense / Large Group Only

Hospital Surgical Medical Expense Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees. H-Ind04.MM-05B


Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-06


Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-06A


Hospital Surgical Medical Expense PPO Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind04.MM-06B


Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-07


Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-07A


Hospital Surgical Medical Expense POS Plan issued to Employer Members of a Multiple Employer Trust who employ at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind04.MM-07B


Major Medical Plan issued to an Employer who employs any number of employees. H-Ind05.MM-01

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CodesMajor Medical / Small Group Only

Major Medical Plan issued to an Employer who employs at least two but not more than fifty employees. H-Ind05.MM-01A


Major Medical Plan issued to an Employer who employs at least fifty-one employees. H-Ind05.MM-01B


Major Medical PPO Plan issued to an Employer who employs any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-02


Major Medical PPO Plan issued to an Employer who employs at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-02A


Major Medical PPO Plan issued to an Employer who employs at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-02B


Major Medical POS Plan issued to an Employer who employs any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-03


Major Medical POS Plan issued to an Employer who employs at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-03A


Major Medical POS Plan issued to an Employer who employs at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-03B


Major Medical Plan issued to an Employer who employs any number of employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind05.MM-04


Major Medical Plan issued to an Employer who employs at least two but not more than fifty employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind05.MM-04A


Major Medical Plan issued to an Employer who employs at least fifty-one employees. A portion of the deductible is an amount reimbursable as a covered benefit and any unused amounts may be carried over into the next calendar year.

H-Ind05.MM-04B

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CodesHospital Surgical Medical Expense / Any Size Group

Hospital Surgical Medical Expense Plan issued to an Employer who employs any number of employees. H-Ind05.MM-05


Hospital Surgical Medical Expense Plan issued to an Employer who employs at least two but not more than fifty employees. H-Ind05.MM-05A

Hospital Surgical Medical Expense / Large Group Only

Hospital Surgical Medical Expense Plan issued to an Employer who employs at least fifty-one employees. H-Ind05.MM-05B


Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs any number of employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-06


Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs at least two but not more than fifty employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-06A


Hospital Surgical Medical Expense PPO Plan issued to an Employer who employs at least fifty-one employees - Includes an incentive to receive covered services through a Preferred Provider Organization, while still providing lesser coverage if a non-participating provider is utilized.

H-Ind05.MM-06B


Hospital Surgical Medical Expense POS Plan issued to an Employer who employs any number of employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-07


Hospital Surgical Medical Expense POS Plan issued to an Employer who employs at least two but not more than fifty employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-07A


Hospital Surgical Medical Expense POS Plan issued to an Employer who employs at least fifty-one employees - Includes the option of seeking covered services at the point-of-service.

H-Ind05.MM-07B

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Major Medical

Major Medical Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers for hospital, surgical and medical expenses for both in-patient and out-patient services.

H-Ind07.ST-01


Hospital Surgical Medical Expense Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers for hospital, surgical and medical expenses for in-patient services and with limited benefits for out-patient services

H-Ind07.ST-02

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Specified Disease / Serious Illness

Health insurance providing benefits for diagnosis and treatment of specifically named disease or diseases. Benefits may be paid as expense incurred, per diem, or a principle sum.

H-Ind01.LB-01 H-Ind02.LB-01 H-Ind03.LB-01 H-Ind04.LB-01 H-Ind05.LB-01

Cancer

Health insurance providing benefits for losses related to the diagnosis and treatment of cancer only. Benefits may be paid as expense incurred, per diem, or a principle sum.

H-Ind01.LB-01A H-Ind02.LB-01A H-Ind03.LB-01A H-Ind04.LB-01A H-Ind05.LB-01A

Critical IllnessHealth insurance providing a principle sum of benefit following diagnosis of specifically named perils.

H-Ind01.LB-01B H-Ind02.LB-01B H-Ind03.LB-01B H-Ind04.LB-01B H-Ind05.LB-01B

HIV Indemnity

Health insurance providing benefits for losses resulting from occupational exposure and infection from the Human Immunodeficiency Virus. Benefits may include some form of occupational income replacement and may be paid as expense incurred, per diem, or a principle sum.

H-Ind01.LB-01C H-Ind02.LB-01C H-Ind03.LB-01C H-Ind04.LB-01C H-Ind05.LB-01C

Organ Transplant

Health insurance providing benefits for treatment related to human and/or non-human organ transplant. Benefits are specific to the delivery of care associated with the covered organ or tissue and may be paid as expense incurred, per diem, or a principle sum.

H-Ind01.LB-01D H-Ind02.LB-01D H-Ind03.LB-01D H-Ind04.LB-01D H-Ind05.LB-01D

Intensive Care

Health insurance providing a daily benefit for confinement in a qualified intensive care unit of a hospital. Benefits are specific to services delivered by the staff of a hospital intensive care unit and do not exceed a stated dollar amount per day.

H-Ind01.LB-01E H-Ind02.LB-01E H-Ind03.LB-01E H-Ind04.LB-01E H-Ind05.LB-01E

PRODUCT NAMES

LIMITED BENEFIT PLANS - PRODUCT DESCRIPTIONS

POLICYHOLDER TYPES & LA DOI PRODUCT CODES


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Disability Income Plans

Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, with different benefit levels for short term and long term disabilities.


Business Overhead Expense

Health insurance providing compensation for business expenses lost because of a disabling injury or illness.


Short Term Disability

Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, featuring a maximum benefit period from one to five years.


Long Term Disability

Health insurance providing compensation for a portion of income lost because of a disabling injury or illness, featuring a maximum benefit period greater than five years and commonly extending to age 65 or the insured's lifetime.


Disability Income / Other

Any other health insurance providing compensation for a portion of income lost because of a disabling injury or illness, not otherwise specified in this Matrix.

H-Ind01.LB-02Z H-Ind02.LB-02Z H-Ind03.LB-02Z H-Ind04.LB-02Z H-Ind05.LB-02Z

Dental

Health insurance providing benefits for routine dental examinations, preventive dental work and/or dental procedures necessary to treat tooth decay and diseases of the teeth and jaw.


Dental / Preferred Provider Organization Plan

Health insurance providing benefits for dental services through dentists participating with an insurer acting as a dental service contractor.



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PRODUCT NAMES



Hospital Indemnity

Health insurance providing a fixed dollar amount in benefits for expenses incurred while confined to a hospital as a result of covered illness or injury. Benefits may be paid as fixed dollar amount per illness, injury or confinement; or as expense incurred with maximum limitations applied per illness, injury or confinement.


Accident Only

Health insurance providing benefits for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.


Vision

Health insurance providing benefits for eye care and eye care accessories. Coverage generally provides a stated dollar amount for annual eye examinations, glasses, contact lens and may include surgical benefits for injury or illness associated with the eye.


Prescription Drug

Prescription Drug Insurance Plan issued to Individual Members of an Assn - Health insurance providing coverage for the costs of drugs that are required by either state or federal law to be dispensed by prescription, excluding those drugs dispensed while confined in a hospital or extended care facility. Drugs for which prescriptions are not required by law may also be covered.


Accidental Death & Dismemberment

Health or life insurance providing a stated benefit in the event of death and/or dismemberment caused by an accident or specified kinds of accidents.


Limited Benefit / Other

Any other limited benefit health insurance not otherwise specified in this Matrix. H-Ind01.LB-49 H-Ind02.LB-49 H-Ind03.LB-49 H-Ind04.LB-49 H-Ind05.LB-49


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PRODUCT NAMES



Short Term Care

Health insurance providing benefits for periods of less than one year, covering medical and non-medical services rendered to ill, disabled, or infirm persons in their home; or for health related services in a nursing facility for the purpose of supporting frail, impaired elderly or other disabled adults who require continued care and attention.


Short Term Care / Home Health Care

Health insurance providing benefits for medical and non-medical services to ill, disabled, or infirm persons in their home for periods of less than one year.


Short Term Care / Nursing Home Care

Health insurance providing benefits for health related services in a nursing facility for the purpose of supporting frail, impaired elderly or other disabled adults who require continued care and attention for periods of less than one year.


Short Term Care / Adult Day Care

Health insurance providing coverage for social and health related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who benefit from care in a group setting outside the home.


Champus / Tri-Care Supplement

A private health plan that provides beneficiaries of the Civilian Health and Medical Program of the Uniformed Services with supplemental health care coverage.

H-Ind02.LB-51


Members



Members

Multiple Employer

Trust

Single Employer

Group

PRODUCT NAMES



Medicare Supplement

Standardized health insurance plans designed to help fill the "gaps" in the protections granted by the federal Medicare program. It supplements reimbursements by Medicare by paying for Medicare's deductibles and co-payments and cannot duplicate any benefits provided by Medicare. It may also cover some services and expenses that are not covered by Medicare.

H-Ind01.MS-01 H-Ind02.MS-01

Medicare Select

A type of Medicare Supplement or "Medigap" insurance plan that restricts policyholder access to specific hospitals and possibly other medical providers within a defined network in order to receive full supplemental benefits.

H-Ind01.MS-01A H-Ind02.MS-01A

1 Assn Grp - Individual Members /

LTC

Individual Family

Group / LTC

1 Assn Group - Employer Member /

LTC

2 Multiple Employer

Trust / LTC

3 Single Employer

Group / LTC

4

Discretionary Group / LTC

Long Term Care /

Qualified

Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-01

H-Ind02.LTC-01

H-Ind03.LTC-01

H-Ind04.LTC-01

H-Ind05.LTC-01

H-Ind06.LTC-01

Long Term Care / Non-Qualified

Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-01A

H-Ind02.LTC-01A

H-Ind03.LTC-01A

H-Ind04.LTC-01A

H-Ind05.LTC-01A

H-Ind06.LTC-01A

Home Health Care /

Qualified

Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home or adult day care setting. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-02

H-Ind02.LTC-02

H-Ind03.LTC-02

H-Ind04.LTC-02

H-Ind05.LTC-02

H-Ind06.LTC-02

PRODUCT NAMES

LONG TERM CARE INSURANCE PRODUCT

DESCRIPTONS



LTC

Individual Family

Group / LTC


LTC

2 Multiple Employer

Trust / LTC

3 Single Employer

Group / LTC

4


PRODUCT NAMES


DESCRIPTONS


Home Health Care / Non-

Qualified

Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home or adult day care setting. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-02A

H-Ind02.LTC-02A

H-Ind03.LTC-02A

H-Ind04.LTC-02A

H-Ind05.LTC-02A

H-Ind06.LTC-02A

Nursing Home Care /

Qualified

Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services while the covered person is confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-03

H-Ind02.LTC-03

H-Ind03.LTC-03

H-Ind04.LTC-03

H-Ind05.LTC-03

H-Ind06.LTC-03

Nursing Home Care / Non-

Qualified

Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services while the covered person is confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-03A

H-Ind02.LTC-03A

H-Ind03.LTC-03A

H-Ind04.LTC-03A

H-Ind05.LTC-03A

H-Ind06.LTC-03A


LTC

Individual Family

Group / LTC


LTC

2 Multiple Employer

Trust / LTC

3 Single Employer

Group / LTC

4


PRODUCT NAMES


DESCRIPTONS


Nursing Home & Home

Health Care / Qualified

Long Term Care health insurance that meets federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home, adult day care setting, or confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-04

H-Ind02.LTC-04

H-Ind03.LTC-04

H-Ind04.LTC-04

H-Ind05.LTC-04

H-Ind06.LTC-04

Nursing Home & Home

Health Care / Non-Qualified

Long Term Care health insurance that does not meet federal IRS requirements to qualify for a tax deduction and provides medically necessary coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a covered person's own home, adult day care setting, or confined to a nursing home. Benefits may be payable on an expense incurred, indemnity, prepaid or other basis.

H-Ind01.LTC-04A

H-Ind02.LTC-04A

H-Ind03.LTC-04A

H-Ind04.LTC-04A

H-Ind05.LTC-04A

H-Ind06.LTC-04A

Long Term Care / Other

Long Term Care health insurance coverage not otherwise defined in this Matrix.

H-Ind01.LTC-99

H-Ind02.LTC-99

H-Ind03.LTC-99

H-Ind04.LTC-99

H-Ind05.LTC-99

H-Ind06.LTC-99

1 Assn Group - Individual or

Employer Member / LTC

Group Long Term Care insurance issued to a professional, trade, or occupational association legally formed and maintained under a constitution and by-laws for purposes other than the procurement of insurance. Additionally, the association: 1) must have had an active existence for at least one year; 2) at the outset, must have a minimum of one hundred members; 3) must hold regular meetings not less than annually to further the purposes of the members; 4) must collect dues or solicit contributions from members other than members of credit unions; 5) members must have voting privileges and representation on the governing board and committees; 6) must make coverage available to employees of members, all of whom are or were actively engaged in the same profession, trade or occupation.


LTC

Individual Family

Group / LTC


LTC

2 Multiple Employer

Trust / LTC

3 Single Employer

Group / LTC

4


PRODUCT NAMES


DESCRIPTONS


2 Multiple Employer

Trust / LTC3 Single Emp Group / LTC

4 Discretionary Group / LTC

Group Long Term Care insurance issued to the trustees of a fund established by two or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof or for members or former members or a combination thereof, of the labor organizations.

Group Long Term Care insurance issued to an Employer to cover employees or former employees or a combination thereof.

Group Long Term Care insurance issued to a group determined by the Commissioner to be in the best interest of the public, would result in economies of acquisition or administration, and providing benefits that are reasonable in relation to the premiums charged.

Policyholder Types

PRODUCT NAMES

BLANKET GROUP - LIMITED BENEFIT PLANS PRODUCT DESCRIPTIONS

LA DOI Product Codes

Hospital Indemnity

Hospital Indemnity Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, providing a fixed dollar amount in benefits to students or teachers for expenses incurred while confined to a hospital as a result of covered illness or injury. Benefits may be paid as fixed dollar amount per illness, injury or confinement; or as expense incurred with maximum limitations applied per illness, injury or confinement.

H-Ind07.ST-03

Accident Only

Accident Only Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, providing benefits to passengers for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.

H-Ind07.ST-04

Limited Benefit / Other

Limited Benefit Health and Accident Insurance Plan issued to a college, school, or other institution of learning or to the head or principal thereof, covering students or teachers, that is not otherwise defined in this Matrix.

H-Ind07.ST-05

Credit Disability Income

Insurance providing monthly loan payments to the creditor/policyholder upon disablement of an insured debtor. H-Ind07.CR-01

Credit / Other Health and Accident Insurance Plan issued to a creditor, that is not otherwise defined in this Matrix. H-Ind07.CR-02

Accident OnlyAccident Only Insurance Plan issued to a common carrier, providing benefits to passengers for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.

H-Ind07.PCC-01

Common Carrier / Other

Health and Accident Insurance Plan issued to a common carrier, that is not otherwise defined in this Matrix. H-Ind07.PCC-02

Accident OnlyAccident Only Insurance Plan issued to an employer, providing benefits to employees, defined by reference to exceptional hazards, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.

H-Ind07.EEH-01

Employer - Exceptional Hazards / Other

Health and Accident Insurance Plan issued to an employer, providing benefits to employees, defined by reference to exceptional hazards, that is not otherwise defined in this Matrix.

H-Ind07.EEH-02

Accident OnlyAccident Only Insurance Plan issued to a volunteer fire department, first aid, or other such volunteer group, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.

H-Ind07.VFD-01

Bla

nket

Gro

up /

Volu

ntee

r Fire

D

ept

Bla

nket

Gro

up /

Pass

enge

rs -

Com

mon

C

arrie

r

Bla

nket

Gro

up

/ Em

ploy

er -

Exce

ptio

nal

Haz

ards

Bla

nket

Gro

up /

Stud

ents

& T

each

ers

Bla

nket

G

roup

/ C

redi

t

Policyholder Types

PRODUCT NAMES

BLANKET GROUP - LIMITED BENEFIT PLANS PRODUCT DESCRIPTIONS

LA DOI Product Codes

Volunteer Fire Dept / Other

Health and Accident Insurance Plan issued to a volunteer fire department, first aid, or other such volunteer group, providing benefits to employees, defined by reference to exceptional hazards, that is not otherwise defined in this Matrix.

H-Ind07.VFD-02

Accident Only

Accident Only Insurance Plan issued to a group, determined by the Commissioner to be subject to the issuance of a blanket health and accident policy, for treatment of bodily injuries or illness sustained only as a result of an unforeseen accident.

H-Ind07.DG-01

Discretionary Group / Other

Health and Accident Insurance Plan issued to a group, determined by the Commissioner to be subject to the issuance of a blanket health and accident policy, that is not otherwise defined in this Matrix.

H-Ind07.DG-02

Bla

nket

Gro

up /

Volu

ntee

r Fire

D

ept

Bla

nket

Gro

up /

Dis

cret

iona

ry G

roup

Policyholder Types

PRODUCT NAMES

HEALTH MAINTENANCE ORGANIZATION PRODUCT DESCRIPTIONS

LA DOI Product Code

HMO / In-Network Only Plan

HMO Plan issued to Individual Members of an Association providing or arranging for the provision of basic and other health care services only through medical providers participating in the HMO's network of health care providers.

H-Hmo01.INO

HMO / PPO Option

HMO Plan issued to Individual Members of an Association with an incentive to receive covered services through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo01.PPO

HMO / POS Option HMO Plan issued to Individual Members of an Association which includes the option of seeking covered services at the point-of-service. H-Hmo01.POS

HMO / In-Network Only Plan

HMO Plan issued to Individual Family Groups, providing or arranging for the provision of basic and other health care services only through medical providers participating in the HMO's network of health care providers.

H-Hmo02.INO

HMO / PPO Option

HMO Plan issued to Individual Family Groups with an incentive to receive covered services through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo02.PPO

HMO / POS Option HMO Plan issued to Individual Family Groups which includes the option of seeking covered services at the point-of-service. H-Hmo02.POS

HMO / Conversion HMO Plan issued to an Individual Family Group under a guaranteed issue right to convert from group HMO coverage for specified reasons. H-Hmo02.Con

HMO / In-Network Only Plan - Any

Size Group

HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo03.INO-01

HMO / In-Network Only Plan - Small

Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo03.INO-01A

Indi

vidu

al F

amily

Gro

up /

HM

OA

ssoc

iatio

n G

roup

- Em

ploy

er M

embe

r / H

MO

Ass

ocia

tion

Gro

up -

Indi

vidu

al M

embe

rs /

HM

O

Policyholder Types

PRODUCT NAMES


LA DOI Product Code

HMO / In-Network Only Plan - Large

Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo03.INO-01B

HMO / Preferred Provider

Organization Option - Any Size

Group

HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo03.PPO-01


Organization Option - Small

Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo03.PPO-01A


Organization Option - Large

Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo03.PPO-01B

HMO / Point of Service Option - Any Size Group

HMO Plan issued to Employer Members of a Bona Fide Association who employ any number of employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo03.POS-01

HMO / Point of Service Option -

Small Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo03.POS-01A


Large Group Only

HMO Plan issued to Employer Members of a Bona Fide Association who employ at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo03.POS-01B


Size Group

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo04.INO-01

Ass

ocia

tion

Gro

up -

Empl

oyer

Mem

ber /

HM

O

Policyholder Types

PRODUCT NAMES


LA DOI Product Code


Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo04.INO-01A


Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo04.INO-01B



Group

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo04.PPO-01



Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo04.PPO-01A



Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo04.PPO-01B


HMO Plan issued to Employers participating in a Multiple Employer Trust who employ any number of employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo04.POS-01


Small Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo04.POS-01A


Large Group Only

HMO Plan issued to Employers participating in a Multiple Employer Trust who employ at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo04.POS-01B

Mul

tiple

Em

ploy

er T

rust

/ H

MO

Policyholder Types

PRODUCT NAMES


LA DOI Product Code


Size Group

HMO Plan issued to an Employer who employs any number of employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo05.INO-01


Group Only

HMO Plan issued to an Employer who employs at least two but not more than fifty employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo05.INO-01A


Group Only

HMO Plan issued to an Employer who employs at least fifty-one employees, providing or arranging for the provision of basic and other health care services to covered employees only through medical providers participating in the HMO's network of health care providers.

H-Hmo05.INO-01B



Group

HMO Plan issued to an Employer who employs any number of employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo05.PPO-01



Group Only

HMO Plan issued to an Employer who employs at least two but not more than fifty employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo05.PPO-01A



Group Only

HMO Plan issued to an Employer who employs at least fifty-one employees, with an incentive to receive covered services to covered employees through the HMO's network of health care providers, while still providing lesser coverage if a non-participating provider is utilized.

H-Hmo05.PPO-01B


HMO Plan issued to an Employer who employs any number of employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo05.POS-01


Small Group Only

HMO Plan issued to an Employer who employs at least two but not more than fifty employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo05.POS-01A


Large Group Only

HMO Plan issued to an Employer who employs at least fifty-one employees, which includes the option of seeking covered services at the point-of-service.

H-Hmo05.POS-01B

Sing

le E

mpl

oyer

Gro

up /

HM

O

Policyholder Types

PRODUCT NAMES

EXCESS / STOP-LOSS PRODUCT DESCRIPTIONS

LA DOI Product Code

Excess Stop Loss / Single

Employer

Individual Excess or Stop-Loss insurance issued to a single employer to cover losses of a self-funded group health plan. H-ESL01-IND

Excess Stop Loss / Multiple Employer Trust

Group Excess or Stop-Loss insurance issued to a multiple employer trust established by two or more employers in the same industry, to cover the losses of each participating employer's self-funded group health plan. Losses of two or more employers may not be pooled. Each employer must be treated separately and independent of other participating employers.

H-ESL01-MET

Exce

ss S

top

Loss

/ S

elf-I

ns P

lan

/ M

EWA Excess Stop

Loss / Self-Ins Plan

Group Excess or Stop-Loss insurance issued to a self-insurer authorized to make, provide or issue a self-insurance plan in Louisiana, including both aggregate and specific coverage and provisions to cover incurred, unpaid claims liability in the event of plan termination or insolvency.

H-ESL02-MEWA

Exce

ss S

top

Loss

/ Pr

ovid

er -

Man

aged

C

are Excess Stop

Loss / Provider -Managed Care

Excess or Stop-Loss insurance intended for issue to protect health care providers from a portion of the financial risk assumed in managed care contracts. H-ESL03-PMC

Exce

ss S

top

Loss

/ Se

lf-Fu

nded

Em

ploy

er

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