Lesson 6 Medical Expense Insurance Flashcards
Basic Medical Insurance
Provides limited coverage to select types of medical care.
Major Medical Insurance
Provides broader, more complete coverage
Taxation of medical expense insurance pertains to people who accumulate medical expenses that add up to ___% of their gross income
7.5
Medical Expense Categories
- Hospital Expenses- daily room/board & misc. never covers physician services
- Surgical Expenses- cost of surgeon and anesthesiologist services
- Physicians Expenses- office visits, no surgical care
- Nurses Expenses- private duty nurse care
- Convalescent Care Expenses- skilled nursing facility expenses
Basic Surgical Expense Methodology
surgical schedule method- every surgical procedure is assigned a $ amount by insurer
Reasonable and customary approach- surgical expenses compared to what is reasonable and customary for that part of country.
Relative Value Scale- assigns points to procedures instead of $ figures
Basic Physicians Expense Policy
covers dr visits while hospitalized for non surgical reason. based on indemnity approach.
xrays, drugs, and dental treatment are excluded
Comprehensive Major Medical Insurance
provide coverage for all major medical expenses under a single policy, not coordinated with basic plans.
low deductible, coinsurance clause, high maximum benefits.
Supplementary Major Medical
can be combined with basic plans to pick up expenses . both supplementary and comprehensive major medical plans contain deductibles and coinsurance
Flat Deductible
states amount that insured must pay before policy benefits become payable.
Corridor Deductible
basic medical policy will pay its limits, then deductible, and then supplementary will pick up remainder.
Integrated Deductible
whatever amount basic medical expense covers is applied to the deductible
Preexisting condition clauses
protect insurers from adverse selection
Preexisting Condition
condition that existed before policies effective date. usually excluded from coverage.
FACT:
HSA’s accumulate tax free funds to be used for medical expenses in high deductible and high out of pocket plans.
Non qualified withdrawals are subject to 10% penalty tax.
HSA’s are fully portable and assets accumulate over years.
upon death HSA ownership may be transferred to a spouse tax free.
in 2015 individual participants must be under age ____ and must be enrolled in a qualified health plan with minimum deductible of _____$ and a _____$ cap on out of pocket expenses
65
$1300
$6650
minimum deductible for family coverage is ____$ and a _____$ cap on out of pocket expenses
$2600
$12,900
in 2015 the maximum annual HSA contribution for self only policies is ____$ and ____$ for family policies.
catchup contributions in the amount of ____$ per year are available to individuals ___ years of age and older
$3350
$6650
$1000
55
Basic Medical Expense Policies
Health policy that provides”first dollar” benefits for specified and limited health care.
characterized by limited benefit periods and relatively low coverage limits.
Coinsurance
company insures only part of potential loss, policy owner pays other part.
Deductible
amount to be paid by insured before health policy starts paying benefits
Hospital Expense Insurance
health benefits subject to specified daily maximum for specified period of time while confined to hospital .
limited allowance for misc hospital expenses like OR, anesthesia, lab fees, etc
Hospital Indemnity Insurance
provides stipulated daily, weekly, monthly indemnity during hospital confinement.
payable on unallocated basis without regard to actual hospital expense.
Limited Risk Policy
coverage for specific kinds of accidents or illness
ex: travel accidents, medical expenses from specific disease
Stop Loss Feature
designed to stop the companies loss at a given point. or placement of a limit on individual out of pocket expenses.
Surgical Expense Insurance
benefits to pay for cost of surgical operations
