Module 7 Flashcards
Define a Small Group
Small group insurance is available for organizations with fewer than 50 full-time equivalent employees.
A type of employee benefit plan that allows employees to pay their share of health insurance premium contributions on a pre-tax basis, reducing their taxable income & increasing their take-home pay.
Premium-Only Plans
This doesn’t apply to firms with fewer than 50 employees.
Employer Mandate
They only represent a single firm to small employers purchasing health insurance.
Captive Agents
They represent several insurers to small employers purchasing health insurance.
Independent Agents (brokers)
Explaining coverage, investigating client options, resolving claims questions/disputes with insurers, & underwriting for the carrier.
Broker and agent activities
It helps insurers determine the level of risk associated with insuring an organization. This information is used to set premiums and determine coverage limits. Agents may get bonuses for low-risk applications, which incentivizes using this process.
Field underwriting
Groups of small employers who come together to pool their employees into a larger group, seeking the lower premiums that large employers enjoy.
Employer coalitions
Nationwide insurance plans that sell coverage to small employers, are exempt from state insurance mandates, and sell coverage more cheaply.
Association Health Plans (AHPs)
Small firms with 50+ full-time workers are required to offer coverage or pay a penalty of $2,000 per employees (excluding the first 30 workers).
“Pay or Play”
Defined by the ACA as averaging 30 or more hours of work per week.
“Full-time” definition
The ACA offers limited duration tax credits for small firms employing fewer than 25 full-time employees that receive annual average wages of less than $50,000 if the employer pays half or more of the premium for qualifying coverage.
Small-Employer Exchange
Employers with a health plan that was operational before March 23, 2010, are allowed to keep their existing plan. Firms may add employees and change insurance carriers, but are limited on the extent to which other features of coverage may change.
Grandfathering
The ACA established individual health insurance exchanges as a mechanism for people to access this type of aid for the purchase of coverage.
Affordable Care Act (ACA) subsidies
The ACA eliminated use of preexisting conditions in setting premiums in the individual market.
Prohibition on preexisting conditions
The individual market provides this type of short-term coverage for people moving from one employer-sponsored plan to another.
Transitional Coverage
The individual market provides this type of coverage for the otherwise uninsured who tend to acquire and drop coverage.
Spells of Coverage
They were intended to enhance competition in the individual market with essential benefits and metal tiers defining comparable product offerings.
ACA-compliant plans
ACA-compliant plans offered by many firms that exited the exchanges. Doing this allowed insurers to sit on the sidelines and reenter the exchange market if the situation improved.
Off-exchange plans
An insurer quoting a premium higher than the standard rate for people with a declinable condition.
Rated-up
Those with high health risks may not buy individual coverage and may instead migrate to public or employer-sponsored coverage.
Selection bias
In insurance, the extent to which people with different risks are combined.
Risk pooling
In the individual market, factors that influence the decision to purchase a particular type of insurance policy show substantial risk pooling, but over a narrow range of expected losses.
Determinants of Choice
Under the ACA, children up to age 26 can be covered under their parents’ group insurance policy.
Coverage under parent’s policies
Imposed by healthcare-sharing ministries to deal with moral hazard.
Lifetime maximum payments
Covering young adults in their parents’ employer-sponsored insurance plans leads to higher premiums that are paid for by wage and benefit reductions to workers.
Compensation differentials
Participant’s annual responsibility for case in healthcare-sharing ministries, which is like a deductible.
Annual unshared amount
Modern examples of fraternal sickness funds. The organization has no legal obligation to reimburse participants’ bills but has an ethical obligation to do so if funds are available.
Healthcare-sharing ministries
For people transitioning from one job to another. Policies use limitations on preexisting conditions to control adverse selection.
Short-term health insurance
