Chapter 12 Flashcards
Who needs health insurance?
The need for health care is greater for individuals who are older, and the average age of the population has increased in recent years. Since older individuals require more health care, the cost of providing health care is rising.
What is the difference in private health care plans when comparing an indemnity plan and a managed health care plan? p. 348
Private health insurance refers to health insurance that can be purchased from private insurance companies to provide coverage for health care expenses. You can purchase this insurance directly from private health insurance companies or through your employer.p.347
Managed health care plans require individuals to receive health care services from specific doctors or hospitals that are part of the plan. You are billed only for services not covered by your insurance.
What is a Preferred Provider Organization (PPO)? pg. 349
is a combina-tion of a fee for service policy and an HMO policy. A PPO allows individuals to select their health care providers and have most of the fee covered
Describe the contents of health care insurance policies according to your text. Pg 351
Identification of insured person - A health insurance contract identifies who is covered—an individual or a family.
Location - Some U.S. insurance companies provide coverage for health care in the United States only, while others provide coverage in non-U.S. countries too. Typically, full health insur-ance benefits are confined to the local area of the beneficiary. Benefits are reduced or eliminated for non-emergency health care received out of the area.
preexisting conditions - A policy may exclude coverage for preexisting conditions, which are health conditions that existed before your policy was granted.
cancellation and renew options - Your health insurance contract should specify if the insurance company can cancel the contract at any time, or if it guarantees continuous coverage as long as the policyholders pay the premiums on time.
What is a preexisting condition and what is a preexisting condition clause in insurance (before Affordable Care Act) according to your text? p. 351
preexisting conditions clause prevents people from buying insur-ance just to treat existing illnesses or injuries.
What determines the amount of medical expenses you must pay (determinants of unreimbursed medical expenses)? p. 352
This amount is determined by the deduct-ible, coinsurance, stop-loss provision, coverage limits, and coordination of benefits,
What is a flexible spending account? p. 353
an account established by an employer for employees to use pretax income to pay for medical expenses. The amount that you set aside each pay period for your flexible spending account is not subject to federal, state, and local income taxes, or to FICA taxes.
COBRA
you can continue your health insurance provided through an employer’s plan for 18 months after you stop working for the employer. The act applies to private firms and state government agencies, but not to federal government agencies.
HIPPA
the act prohibits insurance companies from denying health insurance cover-age based on an applicant’s health status, medical condition or history, previous health insurance claims, or disability. The act is especially important for workers who have pre-existing medical problems.
Affordable Care Act
The provisions of this law require that U.S. citizens obtain health insurance, and use the insurance so that they maintain their health, in an effort to prevent serious health problems. At the time the law was passed, more than 50 million people in the United States did not have health insurance.
How long can young adults stay on their parent’s insurance under the affordable care act?
to the age of 26
What is the purpose of long term care insurance plans? p. 356
covers expenses associated with long-term health condi-tions that cause individuals to need help with everyday tasks.
What is disability insurance? P. 358 How are the rates determined?
provides income to policyholders in the event that they become disabled.
Individual Disability Insurance. You can purchase individual disability insurance and specify the amount of coverage that you desire
Employer Disability Insurance. About half of all large and medium-sized firms offer an optional disability plan through an insurance company.
Insurance from Social Security. If you are disabled, you may receive some income from the Social Security Administration.
Insurance from Social Security. If you are disabled, you may receive some income from the Social Security Administration.
