Chapter 2 / Types Of Health Policies Flashcards
Who are the parties in a group health contract?
The employee and the insurer
What type of health insurance would pay for hiring a replacement for an important employee who’s become disabled?
Key-person disability insurance
What is the primary purpose of disability income insurance?
To replace income lost due to a disability
How are HMO territories typically divided?
Geographic areas
How can a HMO member see a specialist?
Referral by a primary care physician
What is the main principle of a HMO plan?
Preventive care
What does the amount of disability benefits that an insured can receive depend on?
The insureds income at the time of policy application
What do individual insureds revive as proof of their group health coverage ?
Certificate of insurance
In what type of health plan are providers paid for service in advance, regardless of services provided?
Prepaid plans
What is the purpose of respite care in long term care insurance?
To provide relief for a major caregiver (usually a family member)
What is the purpose of a buy-sell agreement for health insurance policies?
To specify how the business will pass between owners, when one of them dies or becomes disabled
Under what type of care do insurers negotiate contracts with health care providers to allow subscribers to access health care services at a favorable cost?
Preferred provider organization (PPO)
What are two types of flexible spending accounts ?
Health care accounts and dependent care accounts
What is the term for a period of time immediately following a disability during which benefits are not payable?
Elimination period
Why do HMOs encourage members to get regular checkups ?
To help catch health problems early when treatment has the greatest chance of success. (I.e. preventive care)
What is the capital sum in accidental death and dismemberment (AD&D) coverage?
A percentage of a principal sum
What types of injuries and services will be excluded from major medical coverage?
Injuries caused by war, intentional self-inflicted, injuries covered by worker’s compensation, regular dental/vision/hearing care, custodial care, and elective cosmetic surgery
With key person disability insurance, who pays the policy premiums?
The business (employer)
In order to be eligible for coverage by HSA, an individual must also be covered by what type of health plan ?
High deductible health plan (HDHP)
In group insurance, what is the name of the policy?
Master policy
Can an insured who belongs to a POS plan is an out of network physician?
Yes, but the copays and deductibles may be higher
What types of groups are eligible for group health insurance?
Employer-sponsored and association-sponsored groups
What is the purpose of COBRA ?
To allow continuation of health insurance coverage for terminated employees
In health insurance, what is considered a sickness.
An illness that first arises while the policy is in focus
What type of hospital policy pays a fixed amount each day that the insured is in the hospital?
Hospital indemnity
What is a free for service health plan
Under a free for service plan, providers receive payments for each service provided.
What is the role of a gatekeeper in an HMO plan?
To control costs for a service of specialists
Who choose a primary care physician in a HMO plan?
The individual member
What are the three types of basic medical expense insurance?
Hospital, surgical, and medical
Can Alzheimer’s disease be excluded from coverage under a long term care policy?
No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered.
