Health-Care Plans - Features of Health-Care Plans

Question 1

7 features of health-care plans

Answer 1

1. deductible
2. coinsurance
3. out-of-pocket maximum
4. preexisting condition clauses
5. preadmission certification
6. second surgical opinion
7. lifetime and yearly limits

Question 2

deductible

Answer 2

the amount an individual pays for services before health benefits become active

Question 3

coinsurance

Answer 3

the percentage of covered expenses or a fixed dollar amount paid by the insured

Question 4

out-of-pocket maximum

Answer 4

the maximum amount a policyholder must pay per calendar year or plan year

Question 5

preexisting condition

Answer 5

a mental or physical disability for which medical advice, diagnosis, care, or treatment was received during a designated period preceding the beginning of disability or health insurance coverage

Question 6

preadmission certifcaiton

Answer 6

Certification by a medical professional of a health insurance company may be necessary before a doctor can authorize hospitalization of a policyholder. Failure to ascertain preadmission certification may lead to denial of hospitalization benefits.

Question 7

second surgical opinion

Answer 7

Reduces unnecessary surgical procedures and costs by encouraging an individual to seek an independent opinion from another doctor

Question 8

Lifetime limits

Answer 8

Refers to the maximum amount a plan would cover

Question 9

Yearly limits

Answer 9

Refers to the maximum amount a plan would cover each year