Types of Accident and Sickness Policies Flashcards
types of employee benefit plan that allows insureds to choose between different types of benefits
cafeteria plan
health insurance that provides coverage for most types of medical expenses
comprehensive coverage
a specified dollar amount that the insured must pay before the insurance company will pay the policy benefits
deductible
risk selection and classification process
underwriting
basic hospital, surgical, and medical policies and major medical policies are grouped as
medical expense insurance
accident and sickness insurance that usually does not require a deductable
first dollar coverage
lists the type of operations covered and their assigned dollar amount
surgical schedule
each surgical procedure will be assigned a number of points that are relative to the number of points assigned to the maximum beneit
relative value
used to supplement the coverage payable under a basic medical expense policy
Supplementary Major Medical Policies
applied between the basic coverage and the major medical coverage
corridor deductible
How was the growth of HMO’s supported in this country?
Health Mainetenance Act of 1973
used for the benefit of preventive care
HMO’s
provides benefits in the form of services rather than reimbursement
HMO
When becoming a member of HMO, you choose a
primary care physician or gate keeper
physicians are paid fees or their services, rather than a salary, but the member is encouraged to visit approved member physicians that have previously agreed upon the fees to be charged
Preferred Provider Organization
group of physicians and hospitals that contract with employers, insurers, or third party organizations to provide medical care services at a reduced fee
PPO
2 ways PPOs differ from HMOs
PPOs do not provide care on a prepaid basis, and subscribers arent required to use physicians or facilities that have contracts with PPOs
combination of HMO and PPO plans
Point of Service
a form of cafeteria plan benefit funded by salary reduction and employer contributions
Flexible Spending Account
for out of pocket health care expenses
health care account
help pay for dependents care expenses which makes it possible for an employee and his or her spouse to continue to work
dependent care account
features higher annual deductables and out of pocke limits than traditional health plans, which means lower premiums
High deductable health plans
designed to help individuals save or qualified health expenses that they, their spouse, or their dependents incur
Health Savings Accounts
designed to replace lost income in the event of not being able to go to work, and is a vital component of a comprehensive insurance program
disability income insurance
a waiting period that is imposed on the insured from the onset of disability until benefit payments commence
Elimination period
purpose is to eliminate coverage for short term disabilities in which the insured will be able to return to work in a relatively short period
elimination period
another type of waiting period that is imposed under some disability income policies
probationary period
refers to the length of time over which the monthly disability benefit payments will last for each disability after the elimination period has been satisfied
benefit period
