Individual Health Products Flashcards

1
Q

Individual Health Products

Insurer Considerations when Choosing Providers for Network

A
  • How restrictive network will be
  • Practice patterns (Quality, Efficiency, adherence to treatment standards)
  • Cost
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2
Q

Individual Health Products

Hospital Indemnity Plans

A

Pays flat amount per day of IP hospitalization

  • Intended to supplement major medical, not replace it
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3
Q

Individual Health Products

Medicare Supplement Plans

A

Covers gap in Medicare coverage, including coinsurance and deductible

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4
Q

Individual Health Products

Regulations that Impact Medicare Supplement Plans (List and Define)

A
  • NAIC Medicare Supplement Insurance Minimum Standard Models Act = Defines benefit designs
  • Balanced Budget Act = High-Deductible plan
  • Medicare Improvements for Patients and Providers Act = Introduced/removed plans
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5
Q

Individual Health Products

Medicare Advantage Enrollment

A
  • Initial Enrollment
  • Annual Open Enrollment (Oct 15 - Dec 7)
  • Special Enrollment
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6
Q

Individual Health Products

Medicare Advantage Bid Process

A
  1. Advance Notice
  2. Announcement
  3. Sponsor submits bid (First Monday in June)
  4. Desk Review (July)
  5. Rebate Reallocation (Early August)
  6. Second actuarial certification
  7. Bids are approved
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7
Q

Individual Health Products

ACA Impact on Medicare Advantage

A
  • Focus = controlling spending increase and improving quality of care
  • MLR = 85%
  • Coverage gap in Part D to be closed by 2020
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8
Q

Individual Health Products

Categories of Renewability for Disability Coverage

A
  • Non-Cancelable (Renew with same rates)
  • Guaranteed Renewable (Renew, but changing rates)
  • Conditional Renewable
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9
Q

Individual Health Products

Business Protection Coverages

A
  • Key Person Coverage
  • Disability Buyout Coverage
  • Business Overhead Expense
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