Chapter 23 Flashcards
a form of protection that eases the financial burden people may experience as a result of illness or injury
Health Insurance
the percentage of medical expenses that the policyholder must pay in addition to the deductible amount
Coinsurance
a provision that requires a policyholder to pay all costs up to a certain amount, after which the insurance company pays 100% of the remaining expenses covered
stop-loss
flat fee that you pay every time you receive a covered service
co-payment
An insurance company that provides hospital care benefits
blue cross
an insurance company that provides benefits for surgical and medical services performed by physicians
blue shield
prepaid health plans that provide comprehensive health care to their members
managed care
health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide health care services in exchange for a fixed, prepaid monthly premium
Health Maintenance Organization (HMO)
group of doctors and hospitals that agree to provide specified medical services to members at prearranged fees
Preferred Provider Organization (PPO)
health insurance plans that use a network of participating physicians and medical professionals who have contracted to provide services for certain fees
Point-of-service (POS) Plan
Federally funded health insurance program available to people over 65 or with certain disabilities
medicare
medical assistance program offered to certain low-income individuals and families
Medicaid
insurance that provides regular cash income when an employee is unable to work due to pregnancy, a non-work-related accident, or illness
Disability Income Insurance
person names to receive benefits from an insurance policy
Beneficiary (Insurance)
insurance that provides protection against loss of life for only a specified term
Term Insurance
a permanent policy for which one pays a specified premium each year for the rest of one’s life
Whole Life Insurance
life insurance that provides coverage for a specific period of time and pays a sum of money to the policyholder if he or she is living at the end of the endowment period
endowment
in a whole life insurance policy, the accumulated savings to which one is entitled when and if one cancels the policy
cash value
stop or interruption
lapse
daily meals
board
extra
supplement
facilities and organizations that provide care for the terminally ill
hospice
good or effective
valid
stop
suspend
suffering
hardship
conditions
provisions
Medical expense insurance covers all the following costs of being ill except…
A. Hospital stays
B. Lost income
C. Doctors’ visits
D. Medications
lost income
Under basic health insurance, aesthesia is considered a…
A. Hospital expense
B. Surgical expense
C. Physician expense
D. Major medical expense
hospital expense
Policies that base benefits on reasonable and customary charges take into consideration the…
A. Average fee for a service in a particular geographical area
B. Fee requirements of service providers
C. Size of the deductible
D. Provisions of co-insurance
Fee requirements of service providers
Which is the statewide organization that provides hospital care benefits?
A. Blue Cross
B. Blue Shield
C. Medicare
D. Medicaid
blue cross
One advantage of a preferred provider organization (PPO) over a health maintenance organization (HMO) is that the PPO covers…
A. Preventive services
B. Emergency care
C. Visits to any doctor
D. Home health care
visit any doctor
Medicare’s hospital insurance covers…
A. Hospice care
B. Long-term nursing care
C. Routine checkups
D. Most immunizations
hospice care
Workers compensation pays benefits to people when they…
A. pay Social Security
B. are covered by an HMO
C. Lose income because of illness
D. Are injured on the job
are injured on the job
The ideal disability income insurance provides…
A. Payments that continue for life
B. 40% of the policyholders income
C. Coverage after accidents only
D. Benefits after a long elimination period
Payments that continue for life
Which type of life insurance lets a policyholder change from term to permanent coverage?
A. Decreasing term
B. Multi Year level term
C. Renewable term
D. Conversion term
conversion term
Beneficiaries wait two years before receiving full death benefits under a common policy feature called…
A. The inconsistency clause
B. A waiver of premium disability
C. The suicide clause
D. Double indemnity
the suicide clause
_________ protects people who are ill or disabled against loss of income.
Disability income insurance
________ is a government health program for low-income individuals and families.
Medicaid
When you stay in a hospital, you are charged for the beds and meals. This is called room and ______.
board
_______ means that the policyholder pays all costs up to a certain amount before coverage begins.
Stop-loss
Facilities and organizations that provide care for the terminally ill are _______.
hospices
A policyholder must pay a(n) _________ when he receives a covered service and the insurer will pay the balance.
co-payment
A(n) ________ in coverage means you do not have insurance for a period of time.
lapse
_________ includes both medical expense insurance and disability income insurance.
Health insurance
A statewide insurance company that provides benefits for surgical and medical services performed by physicians is ________.
blue shield
A(n) ___________ is a managed-care option based on the idea that preventice services will minimize future medical problems.
HMO (Health Maintenance Organization)
The percentage of medical expenses that a policyholder must pay in addition to the deductible amount is called ___________.
coinsurance
Vision care and prescription services that are usually available for an extra fee are known as _________ services in an HMO.
supplement
__________ pays a benefit only if you die during the time period it covers.
Term insurance
A(n) __________ is a managed care option in which you receive care from a pre-approved provider for little or nothing, or you can seek outside care for a higher fee.
POS (Point-of-service) plan
___________ provides a death benefit and a savings component.
Whole life insurance
It is important to carefully analyze and understand all the ___________ of your life insurance policy so you know the terms and benefits.
provisions
Many disability insurance policies are ______ only until you turn 65.
valid
The accumulated savings of a whole life insurance policy is known as the ________.
cash value
________ is a government health program for people over 65 or with certain disabilities.
Medicare
Some disability insurance policies will ________ premiums if you become disabled.
suspend
A person named to receive the benefits from an insurance policy is known as the _________.
beneficiary
A(n) ___________ is a managed-care option in which a group of doctors and hospitals agree to provide specified services to members at prearranged fees.
PPO (Preferred Provider Organization)
Life insurance is necessary when your death might cause financial ________ for someone else.
hardship
A statewide insurance company that provides hospital care benefits is _________.
blue cross
__________ insurance pays a sum of money at the end of the specified time period to the policyholder or the beneficiary.
Endowment
Prepaid health plans that provide comprehensive health care to their members are known as _________.
managed care
