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
