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The social security systems that, perhaps more than any other governmental programs, have characterized the development of industrial societies are under siege. On the threshold of the twenty-first century, the future of social insurance is uncertain; it may even be seriously threatened.
In this important book, nine leading scholars probe deeply into the nature of social rights, trying to read the near future and locate the most meaningful and effective role that social insurance can play as today's new socioeconomic patterns develop.
In-depth chapters analyse existing systems and recent and ongoing reforms in seven countries--Germany, the United Kingdom, Sweden, the United States, Japan, Taiwan, and China. There is also a chapter on the European Union's work toward a harmonised scheme to match other programs of integration, and a chapter on the all-important interpenetration of social insurance and human rights. The authors clearly demonstrate that the unprecedented challenges faced by social insurance today arise not only from changes in the patterns of society, but also from lack of confidence and ideological prejudice on the part of both academia and public policy.
As a major analysis of why and how a great milestone in human progress is faltering under contemporary pressures, this book is of enormous value. It deserves to be read and absorbed by all professionals in the field who want to use their knowledge and skill to ensure a future in which every man, woman, and child is provided with opportunity to live as full a life as possible.
Insurers have a right to require that those applying for insurance will truthfully answer all questions contained in their application, and they then rely on the statements made by an insurance applicant. But what happens when an application for life, health, or disability insurance contains misrepresentations or intentional concealments? This comprehensive publication provides practitioners with a national survey of each of the fifty states, the District of Columbia, and the federal circuits regarding misrepresentations in applications as well as the applicable case law interpreting relevant statutes and developing the common law regarding misrepresentations. It also discusses the important evolving issues related to misrepresentations in the context of the Employee Retirement Income Security Act ("ERISA"). This is a useful tool for any practitioner, whether representing an insured, an insurer, or in-house counsel. Covering the full gamut of issues arising in the application process, including what constitutes a misrepresentation, how a policy is appropriately rescinded, and the defenses that may be raised to contest a decision to rescind a policy, it is logically organized by jurisdiction. Chapters address how state common law and statutes address misrepresentations in the life, health, and disability insurance application context. In addition, there is a chapter for each federal circuit that provides an overview of misrepresentations in the context of an employee welfare benefit plan governed by ERISA.
Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.