Accidental means: the cause AND the result must be unexpected.

Accidental bodily injury: only the result must be unexpected, so it is broader.

Accident = sudden and unforeseen; sickness = develops in the body.

Copayment = flat dollars; coinsurance = a percentage.

Coinsurance normally starts after the deductible is met.

Stop-loss caps the insured's share; then the insurer pays 100%.

Elimination period: starts with each disability (a time deductible).

Probationary period: once, from policy issue, for sickness only.

Group health waiting period: no more than 90 days (federal).

Waived premiums are never repaid.

Gatekeeper = the PCP who refers to specialists; an OB-GYN may qualify as a PCP.

Employer = master policyholder; employees get certificates.

Extension of medical expense benefits: at least 12 months for the disabling condition.

No preexisting condition exclusions in California group or nongrandfathered individual health plans.

Ladder: cancellable → optionally → conditionally → guaranteed renewable → noncancelable.

Guaranteed renewable: to age 50, or 5 years if issued after 44; class rates can rise.

Noncancelable: renewal guaranteed AND premium locked.

Health status or claims never justify nonrenewal of an individual health plan.

Critical illness = lump sum; hospital indemnity = fixed amount per day.

Credit disability pays the loan installments during disability.

Per-day limited benefit plans exclude long-term care.

Specialized health insurance = one area (dental-only, vision-only, behavioral health-only).