Medical Expense Insurance Flashcards
Basic medical expense insurance sometimes called “first dollar insurance” does what?
Provides benefits up front without having to satisfy a deductible
The fee charged by a physician or other health professional is called a what?
Usual, customary and reasonable expense
Hospital expense policies are covered when?
While the insured is confined in a hospital
What are the limits on these policies for number of days and deductible limits?
No specific amount
Surgical schedule approach?
Every surgery cal procedure is assigned a dollar amount by the insurer
Usual, customary, and reasonable approach?
Surgical expense is compared to what is deemed reasonable and customary for the geographical part of the country where the surgery was performed.. this is the maximum amount an insurer will consider eligible for reimbursement under a health plan.
Relative value approach?
Instead of a flat dollar amount like the surgical schedule method, a specified set of units is assigned. It will carry a filler per units amount to determine the benifit known as the conversion factor
Major medical expense plans differ from basic medical expense plans how?
They usually carry deductibles, coinsurance requirements and have large benefit maximums
Coverage under major medical expense plans is provided for what?
Both inpatient and outpatient hospital expenses
Drug formulary is what?
The list of prescription drugs covered by a pharmacy benefit
supplementary major medical?
Provides coverage for expense that were not covered by basic policy
Comprehensive major medical?
Combines the features of basic expense coverage and major medical coverage, sold as one policy
Deductible?
The specific dollar amount an individual is required to pay before insurance benefits are paid
Deductibles are used primarily to help control the cost of premiums and reduce over-utilization of medical services.
True
The term “deductible” is use most frequently with major medical insurance policies
True dat nigga
Flat deductible?
A stated dollar amount that applies to a covered loss. Sometimes referee to as an “initial deductible”
Corridor deductible?
Applied after the basic coverage has been exhausted after a major medical policy is supplementing the basic coverage. Ifffffff it contains no deductible
Integrated deductible
Used when a major medical plan is supplementing basic coverages.
Per cause deductible
Insured must pay each deductible for each accident
All cause deductible
Insured only has to meet the deductible once during the benifit period
Carry over provision
Allows insured to defer current health charges to the following years deductible instead of the current years. Also the period normally applies to the expense incurred during the last three months of the plan year
Coinsurance
Sharing of expenses by the insured and the insurer and its purpose is to reduce over utilization of the coverages
Also wth coinsurance…
After the insured pays the deductible the insurance company pays up to 75-80% of the additional expense leaving the rest to the insured, hence the term “coinsurance”
Stop loss provision
Limits the amount of an insureds out of pocket medical expenses
Also with stop loss
It will state that after the insured has paid a specific amount toward his covered expense the insurer will pay 100% of the remaining
Who is a health savings account available to?
Individuals who are enrolled in a high deductible health plan
Are the funds contributed to an account in a HSA subject to federal income tax?
Fuck no
Who are HSA’s owned by?
The individual
Are HSAs tax-deductible?
Yes
What are HSAs designed for?
Help individuals safe for qualified health expense that they and their families incur
What are health reimbursement arrangements?
They are employee funded, tax advantaged health benifit plans that reimburse employees for out of pocket medical expenses and individual health insurance premiums
Reimbursements may be tax free if the employee paid for qualified medical expenses or a qualified medical plan
True
Who are health reimbursement arrangements established by?
Employer
What’s the purpose of medical savings accounts?
Help employees of small employers pay for their medical care expenses. They are tax feee accounts set up with banks and insurance companies
Med savings accounts are available for employers with no more than?
50employees
Hospital indemnity policies?
Pays a specified amount on a daily, weekly or monthly basis to the insured while the insured is confined to a hospital
