GROUP HEALTH POLICIES Flashcards
PPO- PRIMARY PROVIDER ORGANIZATION POINTS
1) SEVERAL DOCTORS TO CHOOSE FROM
2) IN NETWORK/ OUT OF NETWORK
3) NO PREVENTIVE CARE
4) PREDETERMINED FEES
MULTIPLE EMPLOYER TRUST-MET
- LESS THAN 10 EMPLOYESS
- ONLY ONE POLICY IS GIVE
- EMPLOYEES IN SAME INDUSTRY CAN JOIN MET
FRANCHISE HEALTH INSURANCE POLICY
- LESS THAN 10 EMPLOYEES
- INDIVIDUALS ARE GIVE A POLICY TO SET UP THEIR BENEFITS
- EMPLOYER & EMPLOYEE PAY PREMIUMS
SELF INSURING PLANS- TPA( THIRD PARTY ADMINISTRATOR)
SELF FUNDIND PLANS, LIKE DELTA, CITY OF ATLANTA
MULTIPLE EMPLOYER WELFARE ASSOCIATIONS ( MEWA)
EMPLOYERS POOL MONEY TOGETHER TO INSURE
EMPLOYEES HEALTH INSURANCE, MUST HAVE A CERTIFICATE OF AUTHORITY
BLUE CROSS/ BLUE SHIELD
1) PAYS UNLIMITED AMOUNT
2) PREPAID PLAN
BLUE CROSS
COVERS INPATIENT -IN HOSPITAL CARE
BLUE SHIELD
COVERS MEDICAL/ SURGICAL EXPENSES- OUTPATIENT
WORKERS COMPENSATION
HEALTH INSURANCE PLAN PROVIDED BY EMPLOYER, THAT COVERS WORK RELATED ILLNESS & INJURIES
4 WORKER COMP BENEFITS
1-MEDICAL BENEFITS
2- REHABILITATION BENEFITS
3- DISABILITY BENEFITS
4-DEATH BENEFITS
TRICARE
MILITARY HEALTH INSURANCE
NON DUPLICATION/ COORDINATION OF BENEFITS
1- INSURED’S POLICY PAYS 80%/ SPOUSE’S POLICY PAYS 20%
BIRTHDAY RULE
WHICH EVER SPOUSES BIRTHDAY COMES 1ST WILL PAY 80%
GENDER RULE
MALE SPOUSE’S POLICY WILL PAY 80% OF THE CHILDREN HEALTH CARE
POINT OF SERVICE PLANS- POS
COMBINES THE BEST OF HMO & PPO PLANS
IN & OUT OF NETWORK OPTIONS
INSURED CAN CHOOSE ANY PHYSICIAN THEY WANT, AS LONG AS THEY ARE WILLING TO PAY THE HIGHER CO-PAYMENTS & DEDUCTIBLES
