Practicing in Pennsylvania: A Guide for the New Dentist March 2016 | Page 45

Internal Revenue Service

Non-duplication of benefits: A part of a contract that relieves a third-party payer of liability for cost of services, if the services are covered under another program. Non-duplication of benefits is distinct from Coordination of benefits because reimbursement is limited to the larger benefit allowed by the two plans, rather than a total of 100 percent of the charges. Also referred to as Benefit-Less-Benefit or Carve Out.

Occurrence coverage: A type of policy in which the insured is covered for any incident that occurs (or occurred) while the policy is (or was) in force, regardless of when the incident is reported or when it becomes a claim. Occurrence insurance for medical liability coverage is rarely offered because of the difficulty in projecting long-term claims costs under this type of policy.

Personal injury liability: Injury, other than bodily injury, arising out of one or more of the following offenses committed in the course of your dental practice:

False arrest, detention or imprisonment;

Wrongful eviction;

Undue familiarity;

Discrimination against patients or prospective patients;

Malicious prosecution or abuse of process;

Libel, slander, defamation of character or disparagement of a person's or entity's goods, products or services; or

Oral or written publication of material that violates a person's right of privacy.

Personal umbrella insurance: Provides additional/higher limits of protection when underlying aggregates are exhausted.

Preferred Provider Organization (PPO): PPOs are managed care organizations that offer certain methods to deliver services, such as networks of providers. Under a PPO benefit plan, covered individuals retain the freedom to choose providers but are given financial incentives (e.g., lower out-of-pocket costs) to use the preferred provider network.

Protected Health Information (PHI): Made up of two components: Health Information and Individually Identifiable Health Information. Health Information relates to the past, present or future health of the individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care. Individually Identifiable Health Information can be used to identify the individual, such as a name or Social Security number.

Residual disability: Partial disability that limits one’s ability to work and results in decreased income.

Tail: Coverage that protects the dentist against all claims arising from professional services performed while the claims-made policy was in effect but reported after termination of the policy.

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