Final Exam - Health Insurance Flashcards
Deductible
amount paid for covered health services before insurance pays
The higher the deductible
the lower the premium
How does the deductible apply?
per individual 2000 per family 3000
Affordable Care Act
provides a waiver for deductibles for preventive check-ups or vaccination, separate deductible for prescriptions, (increase deductible and create HSA)
Coinsurance
% of costs you pay for health services AFTER paying deductible (20/30%)
Copay
flat dollar paid for doctor visits and prescriptions
Purpose of copay is?
discourage over utilization
Does copay apply to vaccinations?
no
Annual stop loss
max amount you will pay out of pocket for deductible and coinsurance. (once reached, insurance will pay the rest)
Preferred Provider Org
Org that use provider in/out of approved network, but deductible and coinsurance is higher, referral not required to see a specialist
Point of service
org that must use a doc in the network and referral is required
Health Maintanence
Org where premium is less and referral required
Advantages of employer sponsered HI
employer pays % of premium, payment excluded from employees, incentives
Best practices
avoid autopilot, select best PPO or HMO, do assessments, create HSA
HSA
a personal tax free account for paying qualified medical expenses
