CH6 Flashcards
What does Medical Expense Insurance provide?
They provide benefits for accidents or sickness
Is there a deductible for basic hospital expense coverage?
NO
What is Medical Expense Insurance also known as? and what is a benefit?
first-dollar coverage
they usually do not require the insured to pay a deductible
What are the three most basic coverages?
Basic hospital, surgical and medical policies
What do Major Medical Policies offer?
They offer a broad range of coverage under one policy
For what are Supplementary Major Medical Policies used for?
to supplement the coverage payable under a basic medical expense policy
What are the two most common types of major medical policies available?
Supplemental Major Medical policies, and Comprehensive Major Medical policies.
In an HMO, what do gatekeepers (PCPs) help control?
They help control the cost of healthcare by only making the necessary referrals.
What is the main difference between a PPO and an HMO?
PPOs allow more flexibility between in-network and out-network providers, in exchange for a higher premium.
What is the main goal of Health Maintenance Organizations (HMOs)?
to provide preventive care to a bigger amount of people.
What are Preferred Provider Organizations (PPOs)?
A group of physicians and hospitals that provide medical care services at a reduced fee.
What can FSAs be used for?
to pay medical and dental expenses for employees and their dependents.
What is a Point-Of-Service (POS) plan?
a combination of HMO and PPO plans.
In-network provider =
out-of-network provider =
lower out-of-pocket costs
higher out-of-pocket costs.
What are Health savings accounts (HSAs) designed for?
to help individuals save for qualified health expenses that they, their spouse, or their dependents incur
What is a Flexible Spending Account (FSA)?
is a form of cafeteria plan benefit funded by salary reduction and employer contributions
What are High-deductible health plans (HDHPs)?
It features higher annual deductibles and out-of-pocket limits than traditional health plans, which means lower premiums (my plan)
What do Health Reimbursement Accounts (HRAs) consist of?
consist of funds set aside by employers to reimburse employees for qualified medical expenses
Nonhealth withdrawals before age 65 =
Nonhealth withdrawals after age 65 =
20% penalty;
no penalty.
What do HRAs allow?
allow employees to roll over unused benefits to the following calendar year
What is Disability income insurance designed for?
To replace lost income in the event of a disability
What is a Presumptive disability?
It specifies the conditions that will automatically qualify the insured for full disability benefits
In a Key person disability, who is the policy owner? who pays the premiums? and who is the beneficiary?
The Business that purchases this insurance policy
What is an Elimination period?
It is a set number of days where the policy starts covering for medical expenses
Probationary periods apply to only what?
sickness, not accidents or injury.
What is Business overhead expense (BOE)?
Is a unique type of policy that is sold to small business owners who must continue to meet overhead expenses
What is a difference between a Group Disability Income Policy and an individual policy?
Group disability plan benefits are based on a percentage of the worker’s income; individual policies specify a flat amount.
In an Accidental Death and Dismemberment (AD&D) what is principal sum and what is capital sum?
The principal sum means the full face amount (100%), and the capital sum is a percentage of the face amount.
Under the AD&D rider, when does the person get the principal sum and when does it get a capital sum?
When the insured losses 2 or more limbs the principal sum is applied (100%) and when the insures losses 1 limb the capital sum is applied (a percentage)
What do Long-term care (LTC) policies provide?
It provides coverage for individuals who are no longer able to live an independent lifestyle and require living assistance at home
What is Skilled care?
It is daily nursing and rehabilitative care that can only be provided by medical personnel
What is Residential Care?
It is provided while the insured resides in a retirement community or a residential care facility for the elderly
What do Long term care policies must do what?
Must be guaranteed renewable.
What is Custodial care?
is care administered by nonmedical personnel.
What is Intermediate care?
It is an occasional nursing and rehabilitative care that can only be provided by medical personnel
T or F
If failed to initiate conversion from group coverage to individual coverage within 31 days, a terminated employee must undergo a new individual approval process, which may require a medical exam.
T
What does The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) require?
It requires any employer with 20 or more employees to extend group health coverage to terminated employees and their families
Coverage for dependents under COBRA may be extended to how many months? and under which events?
36 months
in the event of the employee’s divorce or death.
What do Limited policies cover cover?
a specific sickness or accident only.
What are Short-term medical insurance plans designed for?
They are designed to provide temporary coverage for people in transition (those between jobs or early retirees)
What do Health insurers must offer under the Affordable Care Act?
They must offer pediatric dental coverage (for children 18 or younger)
