test Flashcards
what factors should consider when deciding what health insurance plan to buy?
- cost of the monthly premium
- how much coverage you will get -medical ailments
3.deductible - co pay
- can i get the doctor i want
how can u purchase health insurance
- employer plans
- group plans
3.cobra plans
what is the cost of insurance fraud to the consumer
your premiums go up
name a well known health care program for low income individuals
medicaid
how can you personally reduce the need to use your health care plan
eat healthy, don’t rush right away, exercise, sleep, avoid risk, hygiene
why do people buy/have health insurance
fear of debt and emergencies like surgery so you dont have to pay out of pocket
why is medicare in trouble
have to be elderly or disabled to receive the benefits. baby boomers are going into retirement and life span getting longer so more people are taking money out of the pot which has caused less money to be able to give out.
what are 3 ways to coverage disability
workers compensation, social security, private income insurance program
why is healthcare so expensive
technology, equipment, increasing number of crime rates, increasing number if elderly
HMO definition
A health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide healthcare services for a fixed prepaid monthly income. 
Blue cross
A state wide organization, similar to private health insurance that provides health insurance and hospital care benefits 
point of service plan
combines features of both HMO and PPO. You are allowed to seek care from physicians outside of the networks, but at a higher charge. 
copayment
A flat fee that you pay every time you visit a doctors office and you receive a covered service 
managed care
prepaid health plans that provide comprehensive health care to their members 
blue shield
A state wide organization that provides health insurance and benefits for surgical and medical services performed by physicians 
medigap insurance
supplements Medicare, by filling in the gaps between Medicare payments and medical cost not covered my medicine
coinsurance
The percentage of the medical expenses, the policyholder must pay in addition to the deductible amount 
deductible
A set amount that the policyholder must pay toward medical expenses before the insurance company pays benefits 
stop loss
A provision that requires the policyholder to pay all costs up to a certain amount after which the insurance company pays 100% of the remaining expenses as long as they are covered in the policy 
The smith family has insurance for all of its family members. Mr. Smith has health insurance that covers 70% of out of hospital expenses including prescriptions after a $500 deductible per person. It’s the beginning of the year and Mr. Smith’s first doctor/prescription expenses total is $2000. What amount will insurance pay?
step one: 2000-500=1500
step two: 1500x.70=1,050(ins. pays)
step three: 2000-1050=950(mr. S pays)
Betty has taken home $1500 a week. Unfortunately she is unable to work and must stay out of work for 20 weeks. What is the total amount Betty will receive for her entire time on disability? How much will Betty be short each week from her normal take home pay?
step one: 1500x.65=975
step two: 975x20=19,500(ins. pays)
step three: 1500x20=30,000(if not injured)
step four: 30,000-18500=10500(losing)
Gus has a health insurance policy that pays 75% of physical therapy costs after a $200 deductible. In contrast, Jim has HMO insurance that charges a flat fee of $25 per visit for each physical therapy session. If they each need 10 physical therapy sessions that cost $60 for each session who is paying the lesser total amount for physical therapy, Gus or Jim? How much less is Gus or Jim paying? 
step one: 60x10=600-200=400
step two: 400x.75=300(ins. pays)
step three 600-300(gus pays)
step four: 25x10=250(jim pays)
step five: 60-25=35
step six:35x10=350(ins. pays)
jim pays $100 less!!!
