Types of Health Policies Flashcards
what do basic hospital, medical, and surgical policies provide?
benefits for the cost of medical care resulting from accidents or sickness
what does basic hospital expense cover?
room and board, misc. hospital expenses
(set dollar amount per day for up to max # of days)
what does basic medical expense cover?
provides coverage for nonsurgical services
what does basic surgical expense cover?
- Pays for surgeons
-list of operations that are covered and assigned $ amount
relative value
operations assigned a # of points relative to the max benefit. Relative value multiplied by the conversion factor( total amount payable per point)
what do Major medical Policies cover?
- comprehensive coverage for hospital expenses
-catastrophic medical expense protection
-benefits for prolonged injury or illness
what are the common types
of major medical policies?
supplemental major medical policies, comprehensive major medical policies
supplemental major medical policies
supplement coverage payable under a basic medical expense policy
pay a corridor deductible before coverage will pay benefits
what is an HMOs main focus?
preventive care
copayments
flat dollar amount that must be paid by the member
who refers members to specialty physicians?
Gatekeeper (primary care physician)
