Types of Health Policies 2 Flashcards
What is a corridor deductible in regards to a Supplementary Major Medical Policy?
What must be paid after limits on the basic policy have been exhausted before Major Medical Coverage will pay.
Employers with 25 or more employees must offer what to their employees as an alternative to their regular health plans?
Health Maintenance Organizations
What is the main goal of the Health Maintenance Organizations?
Reduce cost of health care by utilizing preventive care.
What does preventive care offer?
Free annual check-ups
Hope to catch diseases in earliest phase
Free/ low-cost immunizations
What do Health Maintenance Organizations and preventive care offer as benefits rather than reimbursement?
Services
What are the characteristics of a Health Maintenance Organization?
Limited service area
Limited choice of providers
Copayments
Prepaid Basis
What happens on a prepaid basis?
The physicians are paid whether or not the services are utilized.
Can a Health Maintenance Organization offer inpatient care out of the service area?
Yes if it is for treatment of:
Mental, emotional or nervous disorder
Alcohol/ drug rehabilitation/ treatment
How are Preferred Provider Organizations different from HMOs?
Paid per service
Subscribers aren’t required to use physicians/facilities that have contracts
If using a PPO approved physician, how much of the cost is covered?
Up to 90%
What is an open panel?
Medical caregiver contracts with a health organization to provide services to members but retains the right to treat non-members.
When are doctors not considered employees of a PPO?
When they are part of an open panel
Preferred Provider Organizations and Health Maintenance Organizations combined to make what plan?
Point of Service (POS) plan
Are employees locked into one plan under the Point of Service Plan?
No. A different choice can be made every time.
What are the Indemnity Plan Features?
If a non-member is used for a Point of Service plan, they will be paid.
Patients pays more.
What are Health Reimbursement Accounts?
Funds set aside by employers to reimburse employees for qualified medical expenses.
Can unused balances under Health Reimbursement Accounts be rolled over to the next year?
Yes
Can Health Reimbursement Accounts follow an employee to a new job?
No
One must be covered by a high deductible health plan in order to have what account?
Health Savings Account
You must not be eligible for Medicare in order to have what account?
Health Savings Account
If a Health Savings Account is used for something non-health related, what are the repercussions?
tax plus 10% penalty
Who does Stop Loss Insurance protect?
Employers who self-insure their employees
Limits out-of-pocket expenses
What does COBRA do?
Any employer with 20 or more employees to extend group health benefits to terminated employees after a qualifying event
How long is coverage extended under COBRA?
Up to 18 months
What is the max an employer can collect premiums from a terminated employee for?
102% of individuals’ group premium rate
How long does insurance under COBRA last for dependents after death, divorce, or legal separation?
36 months
What does HIPAA do?
Regulates protection for both group health and individual policies.
Define Skilled Care
Daily nursing care that can only be provided by medical personnel under the direction of a physician
Define Intermediate Care
Occasional nursing care that’s ordered by a physician. Care by skilled personnel.
Where can Intermediate Care be carried out?
Nursing home
Intermediate Care Unit
Patients Home
Define Custodial Care
Care to meet personal needs: eating, dressing, bathing. Nonmedical personnel.
What is Home Health Care
Skilled nurses or other professional services in one’s home.
Occasion visits by registered nurses.
Maybe physical/ speech/ occupational therapy
What is Respite Care?
Gives relief to the family caregiver for short periods of time
What is Home Convalescent Care?
In home under a planned program established by the attending physician.
Limited Benefit Plans: Dread Care
For specific diseases such as cancer or heart disease.
How is Critical illness Policy paid?
Lump sum upon diagnosis
