CH9: Health and Disability

Question 1

what is health insurance

Answer 1

eases financial burden experienced from injury or illness

Question 2

what does health insurance include?

Answer 2

medical expense and disability income

Question 3

What is the purpose of group insurance

Answer 3

most individuals covered under employer-sponsored plan, paying most of cost

Question 4

Affordable Care Act and Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Answer 4

protects employees from losing coverage because they change jobs

Question 5

Individual Health Insurance

Answer 5

people without access to employer-sponsored program; pick which company to buy from

Question 6

COBRA

Answer 6

employers must offer coverage to employees and dependents for a period of time after a layoff, quit, firing

Question 7

What are the employee repsonsibilities under COBRA?

Answer 7

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

Question 8

What is included with basic health insurance coverage?

Answer 8

hospital expenses, surgical expense, and physician expenses

Question 9

Hospital expense coverage

Answer 9

pays part/all of hospital stay: room, board, whatever else

Question 10

Surgical expense coverage

Answer 10

pays part/all of surgon’s bill

Question 11

Physician expense coverage

Answer 11

pays for part/all of physician’s bill–such as xrays, lab tests, office visits

Question 12

Major Medical expense coverage

Answer 12

covers expenses for a serious injury or long-term illness

may include deductible, coinsurance, and stop-loss provision

Question 13

comprehensive major medical insurance

Answer 13

low deductible offered without separate, basic plan

covers hospital, surgical, and others

Question 14

Dental expanses insurance

Answer 14

covers exams, xrays, cleaning, root canals, oral surgery

Question 15

Psychology of Dread Diseaes Policies

Answer 15

pays very specific conditions, illegal in several states; sold door-to-door, newspapers, mail

Question 16

long-term care insurance

Answer 16

covers daily help if seriously ill or disabled, nursing homes and in-home care
useful for the 100,00-$2,000,000 makers

Question 17

Provisions in a healthcare policy

Answer 17

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

Question 18

a health insurance plan should…

Answer 18

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

Question 19

Private healthcare plans

Answer 19

private insurance, hospital and medical service plans, HMOs, PPOs, POS, home health care agencies, employer self-funded health plans

Question 20

Private Insurance

Answer 20

provide mostly group insurance plans to employers, employers offer to employees, employees pay whatever employer doesn’t

Question 21

Hospital and medical plans

Answer 21

blue cross: hospital care

Blue shield: surgicaland medical services

Question 22

Health maintainance organization

Answer 22

contracts with select provider, fixed pre-paid monthly premium, focus on prevention and awareness

Question 23

Preferred provider

Answer 23

several providers to choose from but costs more than an HMO; more choices, fewer restrictions; pay more if use non-PPO

Question 24

Point of Service

Answer 24

combines HMO and PPO

Question 25

Health Spending Account (HSA)

Answer 25

money contributed to tax-free account to use on medical expenses; balance does roll forward

Question 26

Health Reimbursement Accounts (HRA)

Answer 26

high deductibles, funded solely by employer and unused funds roll to next year

Question 27

Flexible Spending Account (FSA)

Answer 27

pre-tax dollars contributed to an account; funds managed buy employer; unused funds are forfeited at the end of the year

Question 28

Medicare

Answer 28

federally funded health care program that covers all people over 65 and with disabilities; does not cover medical expenses

Question 29

4 parts of Medicare

Answer 29

A: hospital
B: doctor
C: hospital + doctor
D: prescriptions

Question 30

Medigap/MedSup

Answer 30

medicare supplement insurance policy; private coverage that fills in A and B gaps

Question 31

Medicaid

Answer 31

medical assistance offered to certain low-income individuals and families; state administered

Question 32

Medicaid benefits

Answer 32

physicians’ services, inpatient and outpatient services, lab services, skilled nursing and home services, prescriptions, glasses, preventative care for < 21

Question 33

Disability insurance

Answer 33

originally designed to protect against loss of income; provides regular cash income lost by employees as the result of an accident or illness

Question 34

SOurces of Disability income

Answer 34

Workman’s compensation, employer plans, social security ( > 12 month disability, starts in 6th month), private income insurance programs (40-60% of income)

Question 35

How can i reduce healthcare costs?

Answer 35

consider a flexible spending account, consider a high-deductable halth plan, ask for generic medicines, use mail-order or legitimate online pharmacy, looked for reduced insurance offerings in state, pharmacy assistance programs, ask if follow-up visits are necessary, think about nonurgent procedures, review statements for billing errors, appeal unfair decisions from medical providers, practive preventative care