Types of Insurance Flashcards
Group Health Plans (GHP)
Health insurance provided to employees by an employer or by an association to its members
Policies are purchased by an employer or employee organization and is offered to eligible participants (a.k.a. Employer-Sponsored Health Insurance)
Medical Cost Sharing Programs
Group of like-minded individuals that agree to come together to help each other pay their medical expenses
Generally faith-based programs for planning unforeseen medical expenses
These programs are not insurance plans, but are exempt from the individual PPACA mandates
Health Reimbursement Account (HRA)
Type of US employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses and, in limited cases to pay for health insurance plan premiums
High Deductible Health Plan
Health plans with larger deductible amounts than traditional insurance plans
The monthly premiums are usually lower, but it will cost the patient more before the insurance will start to pay
A HDHP can be combined with a HSA allowing the patient to pay for medical expenses with tax free money
The IRS sets the definition of what deductible amounts would be considered high deductible
The total out-of-pocket amounts must include deductibles, copayments, and coinsurance for in-networks services per guidelines
Health Savings Account (HSA)
A type of savings account that lets someone set aside money on a pre-tax basis to pay for qualified medical expenses
By using untaxed dollars in a Health Savings Account (HSA) to pay for deductibles, copayments, coinsurance, and some other expenses, it can lower the overall health care costs
Indian Health Services (IHS)
Agency within the Department of Health and Human Services (DHHS) responsible for providing federal health services to American Indians and Alaska Natives (refer to Payer of Last Resort)
Individual Health Insurance
Health insurance not purchased through an employer or association, but by a private consumer
Medicaid
A health care program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities
Administered by states, according to federal requirements and funded jointly by states and the federal government
Medicare
Federal program providing insurance coverage for the elderly (age 65 and older), anyone who is permanently disabled or with end stage renal disease (ESRD)
Third Party Liability (TPL)
Is purchased to protect the policyholder against liability for damages or losses caused by the named insured to another person or their property
e.g., liability coverage under an automobile policy, homeowner’s liability coverage for personal injury caused by the insured
Tricare
Formerly known as CHAMPUS
The health care program for uniformed service members, retirees, and their families around the world
Is a civilian care component of the Military Health System, although historically it also included health care delivered in the military medical treatment facilities
Veterans Affairs (VA) Healthcare Coverage
An beneficiary is able to have both Medicare and VA coverage at the same time, but not able to use them simultaneously. If using a visit at a VA facility, Medicare will not cover the service. The only exception is treatment referred to a non-VA hospital. In that case, Medicare can be billed to cover services the VA won’t allow or cover
Veterans Affairs (VA) Healthcare Coverage
America’s largest integrated health care system
The Department of Veteran’s Affairs is required by law to provide eligible veterans hospital care and outpatient care services that are defined as “needed.”
VA defines “needed” as care or service that will promote, preserve, and restore health
A veteran eligible for care can receive it from an VA doctor or facility, but not all VA healthcare benefits are available to all veterans
Worker’s Compensation (Work Comp)
Form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee’s right to sue their employer for negligence
