Medical Expense Insurance Flashcards
medical expense insurance
hospital care, physician services, labs, drugs, ect
hospital expense
covers room and board and misc expenses while person is confined into the hospital; limits may not provide full amount, and people are given a specific dollar amount per day; no deductible
surgical expense
pay for surgeon’s services in or out of hospital
relative value scale
each surgical procedure will be assigned a number of points that are relative to the number of points assigned to the max benefit; max point are assigned to major procedures
basic medical expense
provides coverage for nonsurgical services and physician provides; limits to those confined in the hospital
- emergency accident
- maternity benefits
- mental disorders
- hospice and home care
- outpatient care
- nurses expenses
major medical expense plans
offers broad range of coverage under 1 policy, this is different from the limited coverage provided under basic medical expense; they provide: 1. comprehensive coverage 2. misc expenses 3. nursing services 4. physician services 5. catastrophic medical expense protection 6. benefits for prolonged injury/illness they usually carry deductibles
type of major medical: supplementary major medical policy
used to supplement the coverage payable under a basic medical expense policy; after basic policy pays, supplemental major medical will provide coverage for expenses that were not covered by the basic policy
type of major medical: comprehensive major medical policy
combo of basic expense coverage and major medical coverage, sold as 1 policy; covers practically all medical expenses, including hospital, physicians, surgical, nursing, drugs, and lab tests; include deductible, coinsurance, and are generally sold on group basis
Before benefits come, the insured is required to pay a ___
deductible
3 types of deductibles
- flat deductible
- corridor deductible=paid in excess by insured
- integrated deductible=amount of money insured must pay before health policies contribute to payment
coinsurance
requires the insured to participate in some of the expenses, typically insured pays 20% and insurer pays 80%
stop loss
limits amount of expense the insured may be exposed to a policy year; states after you pay a specific amount, insurance company will pay 100% for the remaining expenses for remainder of the year
health savings accounts
saving for qualified health expenses; are tax deductible because individuals contribute; contributions by employer are not included in individuals’ taxable income
hospital indemnity/fixed rate policy
provides an amount on daily, weekly, or monthly basis while insured is confined to the hosptial
limited benefit policies
benefits paid for limited coverage for specific accidents or sickness; may be paid by reimbursement or indemnity basis. types: limited risk, critical illness
