Health Insurance Ch 2 (16%)

Basic hospital, surgical, medical policies, and major medical policies as a result of accident or sickness

Non surgical services a physician provides. No deductible, room and board set at specific price

Assigned a number of points that are relative to the number of points assigned to the max benefit of a surgical procedure

Supplements the coverage payable under a basic med expense policy.

After the limits of the basic policy are exhausted, insured pays this before major medical kicks in.

Congress supported the growth of health maintenance orgs (HMO) for those with 25 employees or more who lived in certain areas, otherwise ineligible.

Providers benefits in the form of services rather than reimbursement. Unique because it Provides financing and patient care for it's members.

Is compensated whether or not services are provided

Physical and are paid fees for their services rather than a salary. Group of physicians & hospitals that contract w/ employers/insurers to provide med care services at a reduced fee, unless it of network, for a higher fee.

1. Don’t provide care on a prepaid basis

2. Not required to use physicians/facilities that have contracts w/ PPO

3. Referral for specialist not required

Combo of HMO & PPO. A different choice can be made depending on the circumstances each time

Plans that allow employers to set aside funds for reimbursing employees for qualified medical exp

Plans designed to help individuals save for qualified health expenses

Funded by salary reduction and employer contributions with annual maximums and “use it or lose it", tax free and limited amount.

Higher annual deductibles & out of pocket limits in exchange for lower premiums

Replaces lost income in the event of being disabled for longer than 90 days

Waiting period that is imposed on the insured from the onset of disability until benefit payments commence. Deductible’s measured in days. Longer elimination periods mean lower premium, benefits start on the day after elimination period ends in arrears, but payments start 30 days after.

Waiting period that does not replace the elimination period but is in addition to it from the start of the policy. Often 10-30 days. Sickness, not accidents. Purpose to reduce adverse selection against the insurer

Disease contracted after policy in force for 30 days

Sold to small business owners, to cover their overhead after occurring a disability like rent, equipment, salaries, utilities, etc. Does not reimburse business owner for their salary. Tax deductible policy, benefits tax though

Special Risk Policy (stuff not usually covered) & Limited Risk Policy (Specific things to be covered)

Provides coverage for at least 1yr in a place other than hospital. Include elimination period that insured must be in nursing home. Guaranteed renewable but premium may increase.

In the insured’s home under a planned program made by the DR.

Provides relief to the family caregiver

Employer w/ 20 or more employees to extend group health coverage to terminated employees. 18 months of coverage, within 60 days of separation.

Provides money while insured is confined to a hospital. Aka, hospital fixed rate policy

Only expenses incurred form specific diseases or causes

Short term

Benefits are tax free

Eyesight and both of the same limb only. Not loss of hearing or 1 limb

No

Cosmetic surgeries

Surgical expense policy

After the insured first pays the deductible

Skilled nursing, intermediate care, and custodial care

6 months

Allows insured to choose btwn different plans

No deductible is required

Policy that pays for the cost of the surgeons services

Coverage for comprehensive coverage for hospital expenses, catastrophic med expense protection, & benefits for prolonged injury with lifetime benefit limit.

To reduce cost with preventative care by using physicians with a prenegotiated price.

HMO recieves a flat rate amount each month attributed to each member

True

pay tax & 20% penalty, unless 65, they pay just tax

1,2,5 yrs until age 65. Longer the benefit, higher the premium

Damage to the body is unexpected and unintended

Disability income policies that specify the conditions that will automatically qualify for full benefits.

To prevent malingering

Yes

Max 50%. May have double indemnity which pays twice as much

Pre existing, mental diseases except for Alzheimer's, drug use addictions, illness from war/suicide attempts, treatment available from government

Must have 100 people for at least two yr with annual meetings

Master contract given to employer with employees receiving certificate of insurance

1-11 months

For heart attacks and stuff, insured money after surviving illness for a while

When insured is diagnosed

Preventative and diagnostic care... Mandatory for those 18 and under