Chapter 8: Health Plans Flashcards
Employer Administered Plans: In ______ plans, the employer provides funding for claim payments for its employees and their dependents.
Self-Funded
The self-funded plan can be supplemented by a ____-_____ contract so the employer’s liability is limited and an insurer will pay the claims in excess of the employer’s expected claims.
Stop Loss
Employer Administered Plans: In ______ plans, the employer provides the funding, and the insurer handles all claims processing.
Administrative Services Only
Employer Administered Plans: In_______ plans, An employer can contract out the claims processing to a _____ (same answer), which will lower the administrative costs that would have been charged by the insurance company.
Third Party Administrator
_______ ______can be used by charitable organizations to fund employee health benefit plans.
Unlike traditional self-funded plans, contributions to these are immediately tax deductible, and earnings grow tax-deferred.
501(c)(9) Trusts
Employers with few employees, usually less than _____ or ____ depending on state law, can establish a small employer health plan.
25 or 50
_____ ____ allow employees to choose which health care benefits and coverages they want from a list of options. This allows employees to pay for and receive health care coverage catered to their unique needs.
Cafeteria Plans - best utilized for larger employers
Health plans can be provided through ______ and _________
These are trusts established by two or more employers to provide health coverage to their employees.
Multiple Employer Trusts (METs)
Multiple Employer Welfare Arrangements (MEWAs)
______ ______ provides medical expense benefits, disability income benefits, rehabilitation and occupational therapy benefits, and a one-time death benefit.
Workers Compensation
_____ plans are employer sponsored plans, such as wellness plans, which foster healthier lifestyles for employees. Such wellness plans focus on healthy diets and physical exercise (e.g., Weight Watchers or Biggest Loser).
Worksite
Two types of “other group” plans?
Blanket
Franchise
_______ plans insure a group of individuals while they are participating in the same activity, such as a group of high schoolers going on a class trip
Blanket
_______ plans permit small groups to obtain health insurance. The coverage usually costs less and contains some of the benefits of group health insurance.
Franchise
TF: Franchise plans are the same as group plans in that the entire group is underwritten under one policy (instead of individual policies)
False - In franchise plans, each individual is issued an individual policy
TF: In a Franchise plan, each individual pays separate premiums
False - the franchise only pays one group premium
TF: Franchise is not technically group coverage
True