Chapter 6. Types of Health Insurance Policies Flashcards
What does the amount of disability benefit that an insured can receive depend on?
The insured’s income at the time of policy application
In group insurance, what is the name of the policy?
Master policy
What is the primary purpose of disability income insurance?
To replace income lost due to a disability
What do individual insureds receive as proof of their group health coverage?
Certificate of Insurance
In order to be eligible for coverage by an HSA, an individual must also be covered by what type of health plan?
High Deductible Health Plan (HDHP)
Who are the parties in a group health contract?
The employer and the insurer
What is the main principle of an HMO plan?
Preventive care
What type of hospital policy pays a fixed amount each day that the insured is in the hospital?
Hospital indemnity
What is the purpose of COBRA?
To allow continuation of health insurance coverage for terminated employees
What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage?
A percentage of the principal sum
What types of groups are eligible for group health insurance?
Employer-sponsored and association-sponsored groups
What is a fee-for-service health plan?
Under a fee-for-service plan, providers receive payments for each service provided
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
What is the role of the gatekeeper in an HMO plan?
To control costs for the services of specialists
What types of injuries and services will be excluded from major medical coverage?
Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care, custodial care, and elective cosmetic surgery
What are the three types of basic medical expense insurance?
Hospital, surgical and medical
What is the purpose of respite care in long-term care insurance?
To provide relief for a major caregiver (usually a family member)
Can an insured who belongs to a POS plan use an out-of-network physician?
Yes, but the copays and deductibles may be higher
How are HMO territories typically divided?
Geographic areas
In what type of health plans are providers paid for services in advance, regardless of the services provided?
Prepaid plans
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
With key person disability insurance, who pays the policy premiums?
The business (employer)
What type of health insurance would pay for hiring a replacement for an important employee who becomes disabled?
Key-person disability insurance
In health insurance, what is considered a sickness?
An illness that first arises while the policy is in force
What are the two types of Flexible Spending Accounts?
Health care accounts and dependent care accounts
Who chooses a primary care physician in an HMO plan?
The individual member
Under what type of care do insurers negotiate contracts with health care providers to allow subscribers access to health care services at a favorable cost?
Preferred Provider Organization (PPO)
How can an HMO member see a specialist?
Referral by the primary care physician
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 for success (i.e., preventive care)
