Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IF7 Healthcare insurance products > Chapter 3 Core healthcare insurance products > Flashcards

Chapter 3 Core healthcare insurance products Flashcards

1
Q

What is the ABI definition of an Acute condition?

A

A disease or illness that is likely to respondquickly to treatment which aims to return you toa the state of health you were in immediatelybefore disease illness or injury or which leads tpyour full recovery
ABI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a definition of a Chronic condition

A 
Needs ongoing or long term monitoring
Needs ongoing or long term control
Requires rehabilitation or training to cope with
Continues indefinitely
No known cure
Comes back or is likely  to come back
Cancer can be exception!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of condition does PMI cover acute or chronic

A

Acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

A patient who gets treated in hospital and stays overnight is known as a what?

A

In patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A patient who is treated in hospital and returns to a hospital bed but does not stay overnight is known as what?

A

Day patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A patient who is treated in hospital but does not have a medically supervised recovery is known as what?

A

Out patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Under regulations Private Medical insurance is classified as what type of insurance?

A

General

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Identify four requirements of the FCA rules on renewal transparency April 2017 which apply to consumer PMI renewals.

A
  1. Changes advised in good time
  2. Last year’s premium in renewal notices
  3. Notice to encourage consumers to check cover and shop around
  4. Additional notice for those consumers have renewed four consecutive times
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Identify three conditions/treatments that are often not covered under PMI

A
  1. chronic conditions
  2. GP consultations
  3. Pre existing conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where are the most expensive hospital bands

A

NHS teaching hospitals and hospitals in centre of London

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What primarily determines in which band a hospital falls

A

Quality of accommodation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If insured uses higher hospital band than they are covered for who pays additional costs

A

Insured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Identify four types of personal private medical insurance product.

A
  1. Comprehensive
  2. Mid range
  3. Basic
  4. International
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Identify five add on benefits that may be provided under a comprehensive PMIpolicy

A
  1. Travel
  2. Gym and fitness club membership
  3. Health screenings
  4. Complementary/alternative therapies
  5. Critical illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Identify six hospital charges paid by a comprehensive PMI policy

A
  1. Accomodation and nursing
  2. Operating theatre facilities
  3. Surgical drugs and dressings
  4. Prostnesis (surgically implanted device)
  5. Day case treatment
  6. Complementary and alternative therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do insurers use to categorise the cost of surgical procedures?

A

2000 procedure codes developedby Coding and ScheduleDevelopment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Under a comprehensive policy what out patient treatments might be covered?

A

Pathology (blood and urine tests)
Radiology (x rays and body scans)
Physiotherapy
Consultations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do insurers limit their exposure to out patient costs

A

Impose annual financial limit or specified number of out patient visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Identify nine other benefits which might be paid under a comprehensive PMI policy

A

Treatment for mental and addictive illnesses
Emergency overseas cover including repatriation
Alternative or complementary medicine
Dental up to annual limit
Eye care is up to annual limit
Cash benefit if use NHS
Cash payment for each night in hospital
Cost of parent guest room
Home nursing facilities
Private road ambulance for hospital transfers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does a mid range policy differ from a comprehensive policy?

A

Limit on out patient benefits

Lower hospital bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Identify the types types of basic policy

A

4 or 6 weeks policy

Limited benefits policy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does a 4 or 6 week policy work?

A

Treatment only paid if NHS waiting list 4 or 6 weeks

Cash benefit paid if use NHS

23
Q

Why have many 4 or 6 week policies been withdrawn?

A

Difficult to police due to varying waiting times so withdrawn

24
Q

How does a limited benefits policy differ from a comprehensive policy?

A

Only cover most expensive treatments eg inpatient
Lower priced hospitals
Exclude psychiatric and addictive disorders
Out patient costs totally excluded or very limitedeg only in certain hospitals, low limit for yearonly following operations

25
Q

What is a medical savings plan?

A

A product that combine medical insurance with a high excess and a regular savings plan to fund the excess eg tax efficient ISA

26
Q

What is a menu cover product?

A

Provides a menu of cover which the insured selects - the more they select the higher the premium
Usually only cover In patient or day patient
Out patient cover for cancer and heart can be added
Different benefits can also be provided eg dental

27
Q

Who pays the premium usually under Group PMI

A

The employer

28
Q

What do Group schemes often pay for which individual policies often do not

A

Pre existing conditions

29
Q

Who pays the premium under an affinity or voluntary scheme?

A

Employee

30
Q

Identify three reasons why employers purchase Group PMI

A
  1. Benefit to attract and retain employees
  2. Minimise impact of medical absences
  3. Enable senior managers to work in hospital
31
Q

Identify 4 types of Group scheme

A
  1. Small under 50 employees
  2. SME 50-250 employees
  3. Large 250 plus employees
  4. Affinity offered by employer but employees pay
32
Q

Identify 5 ways Group schemes are funded

A
  1. Fully insured
  2. Risk/profit share
  3. Cost plus
  4. Self insured
    5, Corporate deductible
33
Q

How does a risk share policy work?

A

If claims are below projected a portion premium is returned to employer

34
Q

How does a cost plus policy work?

A

Employer pays claims plus handling costs subject to stop loss policy which will cap the maximum payable.
Claims are paid out of fund - balance returned at end of year if not used

35
Q

How does a self insured policy work?

A

Usually under a trust arrangement claims are self funded by employer although notional premium calculated for tax benefit purposes

36
Q

How does a corporate deductible policy work?

A

Employer selects large deductible eg £1.5m per year r Insurer only charges for insurance excess of deductible plus administration costs thus save employer IPT.

37
Q

What is a flexible benefit scheme?

A

Employees choose the benefit they require from a menu?

38
Q

What other benefits may be available under a flexible benefit scheme other than PMI?

A 
Life
Long term disability
Critical illness
PMI
Dental
Personal accident
Travel
39
Q

Identify four advantages of a flexible benefits scheme

A

Employee choose benefits for lifestyle
Employees can upgrade
Savings on NICs and tax
Schemes can harmonise benefits after merger

40
Q

Identify four disadvantages of a flexible benefit scheme?

A

Costs of administering scheme
Some employees not take advantage
Employers may use to reduce their costs
Payroll systems can not cope

41
Q

What are benefit limits?

A

Table in policy setting out maximum insurers will pay per procedure statingmaximum payable daily, weekly,annually or per procedure

42
Q

Other than limiting insurers’ exposure how does the specialist fees limit also help PMI insurers

A

Indicates to specialists how much they cancharge

43
Q

identify three types of discounts

A

Affinity
Payment
Earned

44
Q

What is an affinity discount?

A

A discount to premium for being a member of an organisation or employee

45
Q

What is a payment discount?

A

Discount for paying premium annually rather than monthly

46
Q

What is an earned discount?

A

Discount for adopting healthier life style

47
Q

How does a health cash plan work?

A

Pay 50-100% of treatment costs up o annual limit

Most used are dental and optical

48
Q

How is the biggest provider of health cash plans?

A

Simplyhealth

49
Q

Give an example of dental minor remedial care

A

Extractions

50
Q

What would be a major dental restorative treatment ?

A

crowns. bridges, dentures

51
Q

Who sells capitation plans?

A

Dentists

52
Q

What happens before a capitation plan begins

A

An initial examination to determine risk group

53
Q

How does a capitation plan works

A

Patient pays monthly fee to capitation provide.
Dentist carries out work for free and recovers cost from capitation provider
Form of budgeting rather than an insurance policy

IF7 Healthcare insurance products (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions