Individual Health Products Flashcards
Individual Health Products
Insurer Considerations when Choosing Providers for Network
- How restrictive network will be
- Practice patterns (Quality, Efficiency, adherence to treatment standards)
- Cost
Individual Health Products
Hospital Indemnity Plans
Pays flat amount per day of IP hospitalization
- Intended to supplement major medical, not replace it
Individual Health Products
Medicare Supplement Plans
Covers gap in Medicare coverage, including coinsurance and deductible
Individual Health Products
Regulations that Impact Medicare Supplement Plans (List and Define)
- 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
Individual Health Products
Medicare Advantage Enrollment
- Initial Enrollment
- Annual Open Enrollment (Oct 15 - Dec 7)
- Special Enrollment
Individual Health Products
Medicare Advantage Bid Process
- Advance Notice
- Announcement
- Sponsor submits bid (First Monday in June)
- Desk Review (July)
- Rebate Reallocation (Early August)
- Second actuarial certification
- Bids are approved
Individual Health Products
ACA Impact on Medicare Advantage
- Focus = controlling spending increase and improving quality of care
- MLR = 85%
- Coverage gap in Part D to be closed by 2020
Individual Health Products
Categories of Renewability for Disability Coverage
- Non-Cancelable (Renew with same rates)
- Guaranteed Renewable (Renew, but changing rates)
- Conditional Renewable
Individual Health Products
Business Protection Coverages
- Key Person Coverage
- Disability Buyout Coverage
- Business Overhead Expense