Final Exam Flashcards
What are the three (3) central topics on the final exam?
- U.S. Private Health Insurance
- Government Programs
- Pricing for Government Programs
When was ACA signed into law?
March 2010
What department implements rules in ACA?
Federal Department of Health and Human Services (HHS)
What were three (3) STATED goals of ACA?
- Reduce the number of uninsured
- Control heatlhcare costs
- Improve health care deliver system
What were two (2) OTHER goals of ACA?
- Add protections for people with insurance.
2. Improve functioning of private health insurance markets.
Define experience rating
A person’s premium is determined by their own expected costs
Define pure community rating
A person’s premium is based on the average expected claims in a geographic area.
Define modified community rating
Allow premium variation ONLY on selected characteristics (e.g. age, smoking status)
What are two ways employers may purchase insurance?
- Self-insure
2. Insurance company
How does the LAW differ in employers self-insure vs. private?
Under ERISA (federal regulation) self-insured plans avoid STATE insurance regulation.
What three (3) parties pay for employer-based insurance?
- Employee (premium)
- Employer (repmium)
- State and federal governments.
What employers struggle to offer health insurance?
- Small employers
2. Employers with many low wage workers
What are the two problems that make small employers struggle?
- Less likely to offer health insurance
2. Less comprehensive insurance
What are six (6) regulations of ACA on Private Insurance Plans?
- Guaranteed Issue
- No Life time Maximum
- Dependents stay on plan until 26
- No pre-existing condition exclusions
- Limits on out-of-pocket costs
- Free preventive care for all new plans
What is meant by “play or pay” in the health insurance market?
Employers with >50 employees must offer affordable, comprehensive coverage OR pay a PENALTY
What are three (3) insurance ACA changes to large employers?
- > 200 employees must automatically enroll unless opt out.
- Tax on “cadillac” health insurance plans.
- Subject to insurance regulations.
What are four (4) insurance ACA changes to small employers?
- Moves from experience rating to modified community rating.
- State level healthcare exchanges (marketplaces)
- Subject to new insurance regulations.
- Some may receive subsidies to help purchase health insurance.
Describe the American Health Benefit Exchanges (3 components)
- Program created by ACA
- Offers premium subsidies
- Organize sale of insurance
- Purchased directly from insurer.
Who run Health Exchanges? (2 components)
- States set rules according to federal guidelines
2. State may opt out if unwilling or incapable.
What are four (4) reasons the Health Exchanges make everyone use the SAME RULES?
- Modified community rating
- Essential health benefits
- Minimum loss ratio
What are three (3) essential health benefits?
- Maternity care
- Mental health services
- Prescription drugs
Employer(Private) Health Insurance is exempted from what four (4) taxes?
- Federal Income Tax
- State Income tax
Payroll taxes (3. Social Security&4. Medicare)
Where are experience ratings used?
1.
