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Disability Insurance > Types of Health Policies 2 > Flashcards

Types of Health Policies 2 Flashcards

1
Q

What is a corridor deductible in regards to a Supplementary Major Medical Policy?

A

What must be paid after limits on the basic policy have been exhausted before Major Medical Coverage will pay.

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2
Q

Employers with 25 or more employees must offer what to their employees as an alternative to their regular health plans?

A

Health Maintenance Organizations

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3
Q

What is the main goal of the Health Maintenance Organizations?

A

Reduce cost of health care by utilizing preventive care.

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4
Q

What does preventive care offer?

A

Free annual check-ups
Hope to catch diseases in earliest phase
Free/ low-cost immunizations

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5
Q

What do Health Maintenance Organizations and preventive care offer as benefits rather than reimbursement?

A

Services

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6
Q

What are the characteristics of a Health Maintenance Organization?

A

Limited service area
Limited choice of providers
Copayments
Prepaid Basis

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7
Q

What happens on a prepaid basis?

A

The physicians are paid whether or not the services are utilized.

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8
Q

Can a Health Maintenance Organization offer inpatient care out of the service area?

A

Yes if it is for treatment of:
Mental, emotional or nervous disorder
Alcohol/ drug rehabilitation/ treatment

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9
Q

How are Preferred Provider Organizations different from HMOs?

A

Paid per service

Subscribers aren’t required to use physicians/facilities that have contracts

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10
Q

If using a PPO approved physician, how much of the cost is covered?

A

Up to 90%

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11
Q

What is an open panel?

A

Medical caregiver contracts with a health organization to provide services to members but retains the right to treat non-members.

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12
Q

When are doctors not considered employees of a PPO?

A

When they are part of an open panel

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13
Q

Preferred Provider Organizations and Health Maintenance Organizations combined to make what plan?

A

Point of Service (POS) plan

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14
Q

Are employees locked into one plan under the Point of Service Plan?

A

No. A different choice can be made every time.

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15
Q

What are the Indemnity Plan Features?

A

If a non-member is used for a Point of Service plan, they will be paid.
Patients pays more.

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16
Q

What are Health Reimbursement Accounts?

A

Funds set aside by employers to reimburse employees for qualified medical expenses.

17
Q

Can unused balances under Health Reimbursement Accounts be rolled over to the next year?

A

Yes

18
Q

Can Health Reimbursement Accounts follow an employee to a new job?

A

No

19
Q

One must be covered by a high deductible health plan in order to have what account?

A

Health Savings Account

20
Q

You must not be eligible for Medicare in order to have what account?

A

Health Savings Account

21
Q

If a Health Savings Account is used for something non-health related, what are the repercussions?

A

tax plus 10% penalty

22
Q

Who does Stop Loss Insurance protect?

A

Employers who self-insure their employees

Limits out-of-pocket expenses

23
Q

What does COBRA do?

A

Any employer with 20 or more employees to extend group health benefits to terminated employees after a qualifying event

24
Q

How long is coverage extended under COBRA?

A

Up to 18 months

25
Q

What is the max an employer can collect premiums from a terminated employee for?

A

102% of individuals’ group premium rate

26
Q

How long does insurance under COBRA last for dependents after death, divorce, or legal separation?

A

36 months

27
Q

What does HIPAA do?

A

Regulates protection for both group health and individual policies.

28
Q

Define Skilled Care

A

Daily nursing care that can only be provided by medical personnel under the direction of a physician

29
Q

Define Intermediate Care

A

Occasional nursing care that’s ordered by a physician. Care by skilled personnel.

30
Q

Where can Intermediate Care be carried out?

A

Nursing home
Intermediate Care Unit
Patients Home

31
Q

Define Custodial Care

A

Care to meet personal needs: eating, dressing, bathing. Nonmedical personnel.

32
Q

What is Home Health Care

A

Skilled nurses or other professional services in one’s home.
Occasion visits by registered nurses.
Maybe physical/ speech/ occupational therapy

33
Q

What is Respite Care?

A

Gives relief to the family caregiver for short periods of time

34
Q

What is Home Convalescent Care?

A

In home under a planned program established by the attending physician.

35
Q

Limited Benefit Plans: Dread Care

A

For specific diseases such as cancer or heart disease.

36
Q

How is Critical illness Policy paid?

A

Lump sum upon diagnosis

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