Basics of Health Insurance Flashcards
What are the two types of insurance providers through “Private insurance”?
Commercial
Health and managed care
list two insured perils
accidental injury
illness
BOTH commercial and managed care providers offer coverage to ___?
Individuals and Groups
Name of government insurance provider on the state level?
Medicaid
Name of the government level insurance provider?
Medicare
Income replacement when disability prevents insured from working?
Disability income
Type of health insurance that covers the cost of medical care and medical services ?
Medical expense - commercial or managed care company
Pays lump sum benefits in event of accidental death or dismembering injury
Accidental death and dismemberment (AD&D)
Private insurance that supplements Medicare
Medicare supplement
Covers the cost of long-term care (nursing home, home health care)
Long-term care
type of health insurance for: dental, vision, prescription drug, specified ‘dread’ disease.
Limited benefits
How many types of health insurance?
6
Covers the cost of medical care and medical services on an indemnity (reimbursement) basis.
commercial insurer-medical expense
Insurance like coverage through the “provider” that combines medical care and insurance services.
Managed care company -Medical expense-
AD&D (accidental death&dismemberment) also covers what other condition?
blindness
Provides care to people under 65 who become totally disabled.
Social security disability
Medicare supplement is also referred to as what other name?
Medigap- “covers the gaps”
Name of insurance plan that the employer holds the contract and each employee is issued a certificate of coverage.
Group insurance
No single type of health insurance policy can cover every health risk. what is the option to do?
instead a variety of policies can address the different risks.
Basic principle that the PPACA (affordable care act) requires 100% participation by americans not covered by employer health plans?
to lower the cost of health insurance by having a maximum # of healthy people in the “pool” and not just sick people.
What are the essential differences between a bronze, silver, gold, and platinum plan of ACA?
the difference is the percentage of essential health benefits paid = to the percentage of copay.
What contract has a set amount of money payable for a claim that is set in stone when the policy is issued?
Valued contract
Whats the name of the contract that pays the amount of actual loss suffered?
Indemnity aka reimbursement
List two examples of a type of valued contract
Life
AD&D (accidental death & dismemberment)
What is an example of a indemnity contract?
Medical expense plan
For the ACA coverage must meet what kind of standards?
Minimum
ACA does not apply to what two types of health insurance?
disability and long term care
When is OEP (open enrollment period)?
Nov 1- Jan 15
When can a person enroll for insurance after open enrollment window has ended?
if a life event qualifies them during a special enrollment period.
What are 5 life events that qualify for the special enrollment period?
- marriage
- birth of a child
- loss of other health insurance
- becoming a US citizen
- release from prison
Name of plan that is for people younger than 30, cannot afford any other health insurance, or want minimal coverage w/ a high deductible and low premium?
catastrophic plan
Under ACA insurance plans issued on or after Jan 1 2014 must cover what?
pre-existing conditions
An insured’s health policy pays a flat rate of 200$ a month if she becomes disabled, regardless of her actual income. What kind of policy does she have?
A valued policy.
Under ACA dependent children are covered under their parents medical plan until the age of?
26
Under ACA- what is the term for when insurers must spend a minimum % of premium money earned on providing health care coverage and improving the quality of health care?
Medical Loss ratio
Medical loss ratio is a standard that insurer’s must follow to ensure that they spend premiums primarily on health care coverage and NOT on ?
business expenses.
What is the name of the contract used to make a clear plan on how to distribute the policy owners business interest/estate.
a buy-sell agreement
When is a statement of good health typically required in the insurance process?
When there is a “reinstatement”
When does coverage become effective if the first premium has not been paid and a conditional receipt has been issued?
At the time of delivery with the collection of premium
What is the source of medical information provided for applicants seeking high coverage amounts?
The attending physician’s statement
How long is a temporary insurance license typically valid for?
90 days
Under the fair credit reporting act, for what purpose can a consumer report NOT be used?
for preparation of a lawsuit
Who is the Certificate of authority, issued by the insurance commissioner, intended for?
The insurance companies and agents
If an agent provide’s false statements about a policy’s benefits to a proposed client during a sale, what offense is committed?
Twisting
how often does an agent have to renew their license? How many hours total? What is the breakdown of the hours of CE required?
every two years
24 hours total
20 hours elective and 4 hours MUST be law and ethics in the license type held.
Can a material misrepresentation made by an insurance agent result in license suspension, revocation, or denial?
yes.
