ch 3: health insurance Flashcards
coinsurance
the amount a patience must pay for major medical care after meeting the deductible
Flexible Spending Account
Employer-sponsored plan that oermits employees to defer pre-tax income into an account to pay for health care expenses. FSAs require the employee to either use the contributed amounts for medical experiences by the end of the year or forfeit the unused amounts to the employer
Group Heath Insurance
health plans offered to a group of individuals by an employer, association, union or other unity
Health Maintenance Organizations (HMOs)
a form of managed care in which participants receive all of their care from participating providers. physicians may be employed by the HMO directly or may be physicians in private practice who have chosen to participate in the HMO network. HMO recipients receive a flat annual fee for each HMO member, whether the member receives medical services from the provider or not.
Health Savings Account
A plan that permits employee or individuals to save for health care costs on a tax-advantaged basis.
Contributions made by the plan participant are tax-deductible as an adjustment gross income, and distributions from the HSA to pay for qualified medical expenses are excluded from income.
High Deductible Health Insurance Plans (HDHP)
Plans with a deductible of at least 1400 for individual coverage and 2800 for family coverage and $2800 and a MOOOP 6900 (single) and 13,800 (family)
incontestability clause
clause that prevents the insurer from challenging the validity of a health insurance contract after it has been in force for specified period of time
indemnity health insurance
traditional, free-for service health insurance that does not limit where a covered individual can get care
Medicare Supplement Insurance (Medigap)
a health insurance policy designed to cover some of the gaps in coverage associated with traditional medicare
Point of Service Plan (POS)
A form of managed care that is considered a managed care/indemnity plan hybrid as it mixes aspects of HMOs PPOs and indemnity plants for greater patient choice.
a primary care physician coordinates patient care, but there is more flexibility in chpoosing hospitals than in an HMO
Preferred Provider Organization (PPO)
form of managed care in which participants have more flexibility in choosing physicians and other providers compared to an HMO.
the arrangement between insurance companies and and health care providers permits participants to obtain discounted health care services from the preferred providers within the network.
