Chapter 15 : Medical Expense Insurance Flashcards
Corridor Deductible
After the basic coverage is exhausted, when a major medical policy is supplementing basic coverage that contains no deductible.
Integrated Deductible
Used when a major medical plan is supplementing basic coverages.
Carryover Provision
Allows an insured to defer current health charges to the following year’s deductible instead of the current year’s deductible.
Stop-loss
Designed to stop the company’s loss at a given point, as an aggregate payable under a policy, a maximum payable for any one disability or the like
Medical Saving Accounts (MSA’s)
Self-employed + small businesses
Individual: $2400
Family: $4800
Catchup: n/a
HDHP Minimum Deductible for Individual: $2400
HDHP Minimum Deductible for Family: $4800
HDHP Maximum Out of Pocket for Individual: $4800
HDHP Maximum Out of Pocket for Family: $8750
Flexible Savings Account/Flexible Spending Accounts
Tax-advantaged accounts that can be set up through a cafeteria plan of an employer.
Employees sets aside a portion of earnings to pay for qualified medical expenses
Limited Risk Policies
AKA Dread Disease Policy
Specific diseases
Paid as a scheduled, fixed-dollar mount for specified perils or medical procedures
Relative Value Approach
Specified set of units assigned to every surgical procedure to determine the benefit.
Non-scheduled plans pay benefits based on ?
Usual customary and reasonable basis
Comprehensive contacts and major medical policies
Surgical Schedule Approac
Every procedure has a dollar amount
Major medial expense insurance
Offers high maximum benefits and broad coverage under one policy written for a one-year term
Intergrated deductible
Used in comprehensive plans (basic + major medical plans)
Individual Mandate
Shared responsibility on the part of most individuals to have minimum acceptable coverage or pay a tax penalty beginning in 2014.
Open Enrollment
November 1 - December 15
Special Enrollment (4)
- Loss of job
- Marriage
- Birth of child
- Divorce
Medical Loss Ratios
Health insurers must spend a % of premium dollars on direct medical costs:
80% - individual market
85% - group market
Bronze Plan
60% - insurer
40% - insured
Silver Plan
70% - insurer
30% - insured
Gold Plan
80% - insurer
20% - insured
Platinum Plan
90% - insurer
10% - insured
Out of pocket maximum
$8550 - yearly, individual
$18,100 - family
HSA
Tax-deductible
Grows tax free; if used for medical expenses then comes out tax free
Penalty 20%
Max contribution: $3600
$7200 : family
55-65 y/os’ can contribute catch of 1000
rollover year after year
Health Reimbursement Accounts (HRAS)
Funded and established by employer
No annual contribution limit
No funds to employees; based on reimbursement
Not portable
Archer Medical Savings Account (3)
Small employers of no more than 50 employees
No contribution limit
Participants must be in a high-deductible plan
Flexible Spending Arrangement
Tax-advantaged accounts setup through a cafeteria plan of an employer.
Cannot join if they have HSA or MSA
Does NOT rollover year to year
Does NOT require participants to have HDHP
Employers cannot reimburse employees
Limits: $2750 yearly
Consumer Driven Health Plan (3 Parts)
- Tax advantage savings
- Corridor deductible
- Qualifying high deductible insurance policy
