Chapter 4: Medical Expense Flashcards
What is Medical Expense Insurance?
Covers hospital care, physician services, drugs, lab work, nursing, surgical expenses
- Does not include care in a government facility
Basic Medical Expense plan
- Upfront benefits
- Lower benefit limits than major medical insurance
- There will still be money owed (copay)
Hospital Expense Policies
- Hospital room and board, labs/x-rays, medicines, operating room and supplies
- insured pays difference left over after benefits run out (set at a dollar amount)
Surgical Expense Policies
- Usually with a hospital expense policy
- Pays for surgical procedure no matter where they take place
Physician Expense Policy
- AKA Basic Physician Nonsurgical Expense Coverage
- Cover emergency accident benefits, maternity, benefits, mental and nervous disorders…
- Limited benefits
Major Medical Expense Plan
- Covers necessary medical expenses
- Catastrophic medical expense protection
- Both inpatient and outpatient hospital expenses
- Drug formulary (pharmacy benefits from list of specific drugs covered)
Supplementary Major Medical
- After basic policy pays, this is coverage for those expenses that were not covered
- Also covers after time limitation has expired on basic policy
Comprehensive Major Medical
- Combines the features of basic expense coverage and major medical coverage, as one policy
- Covers practically all medical expenses
Deductibles
- states dollar amount that the insured is required to pay before insurance benefits are paid
- Helps control cost of premiums and reduce over utilization of medical services
Flat Deductible
Stated dollar amount that applies to a covered loss
Corridor Deductible
- This Deductible is not applied until the basic coverage has been exhausted
Per-Cause Deductible
The insured must satisfy a deductible for each accident or illness
All-Cause Deductible
The insured only has to meet the deductible amount once during the Benefit period
Carryover Provision
- Allows insured to defer current health charges to the following years deductible instead of the current years deductible (applies to expenses incurred during the last three months)
Coinsurance
- Share the cost of expenses with an insurance company
- Insurance covers 75 to 80 percent
- Insured usually pays 20%
Stop-Loss
- Designed to limit the amount of an insureds out of pocket medical expenses
- States after the insured pays specific amount the insurance will pay 100% of remaining expenses
Health Savings Accounts
Tax-advantage medical savings account for those that enroll in a high deductible health plan
No tax payment needed
Health Reimbursement Arrangements
- Employer funded tax-advantaged health benefit plans that reimburse employees for out-of-pocket medical expenses and individual health insurance premiums
Medical Savings Accounts
Help employees of small employers pay for medical care expenses
- available for businesses with fewer than 50 employees
Hospital Indemnity Policies
Pay a specified amount on a daily, weekly or monthly basis to the insured while the insured is confined to a hospital
Limited Risk (dread disease) policies
Provides benefits for a specific disease such as cancer or heart disease
Type of limited health insurance policy
Critical Illness Policies
Pays a lump sum to the insurance upon the diagnosis of a critical illness
What is the elimination period in a hospital indemnity plan?
The specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization
Hospital Indemnity Insurance
Provides benefits when you are confined to a hospital
