Exam 3 Part D Flashcards
1
Q
Managed Care Plans
A
HMO (Health Maintenance Organization
2
Q
HMO
A
- Health Maintenance Organization
- Removes incentives present under fee for service plans to do more rather than less
- Does not pay providers by just doing more
- Places providers/ hospitals at financial risk for over utilization
3
Q
Types Of HMOs
A
- Staff Models
- Group Model
4
Q
Staff Models
A
- Physicians are EEs of the HMO
- Paid by a salary
- Only see HMO patients
5
Q
Group Model
A
- Physicians are EEs of a separate group practice or part owners in the group practice
- HMO enrolls individuals and contracts with group practice to take care of HMO patient
- Group practice can see HMO and non HMO patients
6
Q
Two Disadvantages to HMOs
A
- May have to change providers to join HMO
2. No coverage for out of plan utilization
7
Q
PPOs
A
- Preferred Provider Organization
- Have contracts with preferred providers (doctors, hospitals, etc)
- Agree to accept the PPO payment and deductibles or co payments as payment in full
- Discount services
- Cannot balance bill
8
Q
Consumer Directed Health Plans
A
- Designed for engaging people to make decisions on health and wellness based on consumerism
- Buy healthcare like other products; car, home
- Introduces consumerism
- Behavior responsible for 50% of healthcare cost
- Force employee to be aware of costs
- Enable empowered consumers
- 80/20 rule; 80% of the cost comes from 20% of population
9
Q
HRA & HSA Accounts
A
- High deductible ($1,000)
- Coinsurance
- Employer Funds account
- Employee can add funds (pre tax)
- If you spend to much, you pay more
- Catastrophic costs per person capped
- Pays 100% of preventative measures
- Focus on health and wellness and behavior
- Savings as opposed to spending
10
Q
Patient Protection Affordable Care Act
A
- Dependents covered to 26
- Lifetime limits are now barred
- $2,000 penalty for ERs who do not offer EE Health Insurance
- Individual Mandate
- Fees from penalties fund government healthcare option
- No charging higher rates for those with pre-existing conditions and coverage of those conditions may not be excluded
- All preventative care and check ups are free
- Taxes 40% on cadillac health plans
11
Q
Eligibility Standards: Pension Plans
A
- Usually more strict than those in other types of benefits
- Usually establish minimum age and minimum service requirements to establish eligibility
- Minimum age cannot exceed 21
- Minimum service requirement cannot exceed one year
12
Q
Retirement Ages
A
- Normal Retirement
- Early Retirement
- Late Retirement
13
Q
Normal Retirement Age
A
- NRA
- Earliest age at which EEs can retire and receive full benefits
14
Q
Early Retirement Age
A
- Earliest age at which an EE may retire and receive some benefit
- Usually paid a reduced benefit (full and equivalent)
15
Q
Late Retirement Age
A
- Retirement after normal retirement age
- ER should increase benefit
- Not required to do so
