Health Insurance Flashcards
(43 cards)
4 major classes of how medical expense insurance is divided
- hospital expense
- surgical expense
- physician’s expense
- major medical
stop loss
the maximum amount that the insured must pay in coinsurance payments
out-of-pocket
insured only pays the out-of-pocket amount as the max for group hospitalization and major medical
what does PPACA stand for?
Patient Protection and Affordable Care Act
what are the 4 benefit categories of PPACA?
- bronze plan
- silver plan
- gold plan
- platinum plan
bronze plan
represents minimum allowable coverage and covers 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the HSA limit
silver plan
covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limit
gold plan
covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limit
platinum plan
covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limit
what does HMO stand for?
Health Maintenance Organization
what is an HMO?
- delivers comprehensive health care in return for a periodic payment (premium)
- care is managed by a primary care physician (gatekeeper) who determines what care is received
what is the primary disadvantage of an HMO?
there is no coverage outside of the HMO
what does PPO stand for?
Preferred Provider Organization
what is a PPO?
- network of health care providers with whom an employer or insurance company contracts
- provider offers a discount on services
- insured receives a high rate of reimbursement when using providers within the organization
- insured may seek care elsewhere, but will suffer a penalty in the form of increased deductibles and coinsurance
- preserves an employee’s option to choose a provider outside of the network
what does PCP stand for?
Primary Care Physician
what does HSA stand for?
Health Savings Account
what is an HSA?
-provide employees and individuals seeking health care a tax deduction for amounts contributed to their accounts as well as use of the money and earnings tax-free for qualifying medical expenses
what is the requirement to be eligible for an HSA?
the individual must have medical insurance under a high deductible health plan (HDHP)
what does HDHP stand for?
High Deductible Health Plan
for whom are HSA contributions deductible?
- for the employee who contributes
- for the employer who contributes
- for any eligible family members who receive contributions on their behalf
when are distributions from an HSA tax-free?
when used for qualified medical expenses
what medical expenses are not considered qualified for an HSA distribution?
- over-the-counter drugs (unless taxpayer has a prescription)
- cosmetic surgery costs
what happens when an individual takes a distribution from an HSA for a non-qualified medical expense?
distributions are subject to income tax and a 20% penalty (if taken before age 65)
what does it mean if a health insurance policy is noncancellable?
- these policies are continuous and guarantee an insured the right to renew until a specified age or stated number of years
- insurer cannot raise premiums and cannot cancel the policy
