CH9: Health and Disability Flashcards
what is health insurance
eases financial burden experienced from injury or illness
what does health insurance include?
medical expense and disability income
What is the purpose of group insurance
most individuals covered under employer-sponsored plan, paying most of cost
Affordable Care Act and Health Insurance Portability and Accountability Act of 1996 (HIPAA)
protects employees from losing coverage because they change jobs
Individual Health Insurance
people without access to employer-sponsored program; pick which company to buy from
COBRA
employers must offer coverage to employees and dependents for a period of time after a layoff, quit, firing
What are the employee repsonsibilities under COBRA?
must file within 60 days of notification or until your coverage expires to elect COBRA
must be employed by private company or state/local government
What is included with basic health insurance coverage?
hospital expenses, surgical expense, and physician expenses
Hospital expense coverage
pays part/all of hospital stay: room, board, whatever else
Surgical expense coverage
pays part/all of surgon’s bill
Physician expense coverage
pays for part/all of physician’s bill–such as xrays, lab tests, office visits
Major Medical expense coverage
covers expenses for a serious injury or long-term illness
may include deductible, coinsurance, and stop-loss provision
comprehensive major medical insurance
low deductible offered without separate, basic plan
covers hospital, surgical, and others
Dental expanses insurance
covers exams, xrays, cleaning, root canals, oral surgery
Psychology of Dread Diseaes Policies
pays very specific conditions, illegal in several states; sold door-to-door, newspapers, mail
long-term care insurance
covers daily help if seriously ill or disabled, nursing homes and in-home care
useful for the 100,00-$2,000,000 makers
Provisions in a healthcare policy
eligibility (age, marital status, dependency), assigned benefits (insurance pays your doctor and hospital directly, internal limit (fixed amount per day in hospital), copayment, service benefits, benefit limits, exclusions and limitations, renewable, cancellation/termination
a health insurance plan should…
offer basic coverage for hospital and doctor bills, provide at least 120 days hospital room and board in full, at least $1 mil lifetime max for each family member, pay at least 80% of out-of-hospital expenses after a yearly deductible of $500 per person or 1,000 per family, impose no unreasonable restrictions, limit out-of-pocket costs to 3000-5000 a year
Private healthcare plans
private insurance, hospital and medical service plans, HMOs, PPOs, POS, home health care agencies, employer self-funded health plans
Private Insurance
provide mostly group insurance plans to employers, employers offer to employees, employees pay whatever employer doesn’t
Hospital and medical plans
blue cross: hospital care
Blue shield: surgicaland medical services
Health maintainance organization
contracts with select provider, fixed pre-paid monthly premium, focus on prevention and awareness
Preferred provider
several providers to choose from but costs more than an HMO; more choices, fewer restrictions; pay more if use non-PPO
Point of Service
combines HMO and PPO
