Health and Accident Flashcards
business overhead expense insurance
designed to help day to day expenses in the event the business owner becomes disabled; includes rent and utilities
TAX-DEDUCTABLE
disability buy-sell
assists in the sell of the business in the event of a disability of the business owner; TAX-FREE because premiums are NOT TAX DEDUCTABLE
key person disability insurance
pays for expenses for additional help when a key person becomes disabled; TAX-FREE
multiple employer welfare arrangement
gives to small, non-affiliated members
multiple employer welfare arrangement
gives to small, non-affiliated members
health maintenance organization
prepaid health services to subscribing members;
delivers said services using their own facilities;
subscribers pay a fixed fee;
only use their doctors and services;
payment for these doctors are called CAPITATION;
CLOSED PANEL: salaried doctors providing services outside of HMO facilities
OPEN PANEL; doctors providing services in their own facilities who work HMO on a part time basis;
stresses PREVENTATIVE CARE;
group of 25 or more employees
preferred provider organization
offer services to a certain group at PREARRANGED DISCOUNT PRICES; unlike HMO, PPO: 1. has a fee for service rendered basis 2. wider choice of physicians 3.
service providers
offers benefits (services) to subscribers in return of payment of premium, i.e. blue cross blue shield
medicare
for people: 65+, people with chronic kidney disease, people with disability 24 months+
Medicare Part A
i.e. HOSPITALIZATION; inpatient care, nursing facilities, care provided in hospice and some homes
Medicare Part B
i.e. DOCTOR SERVICES
Medicare Part D
drug coverage; MUST have A or B in addition
SSDI
must be completely disabled in order to not attend gainful work, and expected to remain as such for 12 months or die in 12 months;
40 credits needed and 5 month waiting period until you can receive SSDI
Medicaid
low income who are blind, disabled, or under 21;
benefits may be applied to medicare deductibles and co-payment requirements
workers compensation benefits
lost wages and medical expenses due to occupational accidents
501(c)(9)
a trust from which benefits are paid from a multiple employer trust
501(c)(9)
a trust from which benefits are paid from a multiple employer trust
total disability considers the person’s:
training, education, and experience
rehabilitation benefit
insured cannot return to original occupation but can work, and rehab needed to return to this new occupation is paid by insurer
probationary period vs. elimination period
probationary: begins at time of policy
elimination: begins at time of disability
probationary period vs. elimination period
probationary: begins at time of policy
elimination: begins at time of disability
hospital expense policies
covers room and board, misc expenses such as xrays so as long as you are in the hospital;
no deductible, limited dollar amount per day
basic surgical expense coverage
covers all surgeon’s fees;
- surgical approach: dollar amount assigned by surgeon
- reasonable and customary approach: dollar amount according to goegraphical location
basic physician expense coverage
coverage for limit of time, such as maternity benefits, outpatient care, ect
major medical expense plans
broad coverage under 1 policy, covers what basic medical expense does, except it has deductibles, coinsurance requirements, and large benefit max
comprehensive major medical
basic expense coverage and major medical coverage all in 1 policy; include deductible, coninsurance, and sold on group basis
deductible
stated dollar amount insured is required to pay before insurance benefits are paid
coinsurance
after deductible is met, both insured and insurer share remaining expenses
stop-loss
limit the amount of expense the insured is exposed to within a given year; after you pay a specific amount of expense, the insurer will cover 100% of remaining expense
health savings account
not subject to taxes, for plans with high deductibles, not covered under other plans, not eligible for medicare, and cannot be claimed by someone’s taxes; are tax deductible; use it to pay for out of pocket medical expenses
health reimbursement arrangements
established by employer only; reimburses for out of pocket medical expenses
