Unit 12 Intro to Health Insurance Flashcards
Health insurance is designed to cover 2 perils:
____ - unintentional bodily injury caused by an unforeseen event; and
____ - a need for medical care due to a cause other than an accident
Accident
Sickness
A ____ condition is an illness or disease that existed before an individual’s health insurance went into effect. The Affordable Care Act eliminated pre-existing condition exclusions for medical expense policies affected by ACA.
However, it is important to note that pre-existing condition exclusions are still allowed for disability policies, long-term care insurance, medicare supplements, and limited benefit policies.
Pre-existing Conditions
____ coverage helps pay doctor and hospital bills. It includes coverage for diagnostic and treatment-related expenses such as lab tests, x-rays, and medical supplies. Many medical expense plans also cover the cost of prescription drugs.
Hospital/medical expense coverage
____ insurance pays a stated amount of income to the insured when an accident or sickness leaves them unable to work for an extended period. While medical expense coverage pays doctor and hospital bills, this insurance provides money to pay other bills. This insurance is frequently referred to as INCOME REPLACEMENT or LOSS-OF-TIME coverage.
Disability Income Insurance
____ insurance is similar to medical expense coverage in the respect that it helps to pay dental bills. Coverage is generally provided for routine dental care such as cleanings, fillings, crowns, root canals, and braces.
Dental Expense Insurance
____ insurance provides coverage for medical and non-medical care for individuals with: chronic illness,, cognitive impairment, or difficulty performing activities of daily living
Long-term Care Insurance
With group insurance, is a medical exam required?
No
Does individual medical insurance cover accidents at work?
Yes, it covers accidents that happen ANYWHERE
Federal health insurance programs:
____ - for active duty and retired military personnel
____ - for discharged military serice members
____ - healthcare primarily for senior citizens and recipients of SS disability
____ - healthcare for individuals and families who are or become poor
____ - for eligible individuals who become totally or permanently disabled
TRICARE
Veterans Benefits
Medicare
Medicaid
Social Security Disability
Limited Plans (1/2)
____ - while medical expense plans cover losses that arise from almost any cause with just a few exceptions, limited benefit plans cover losses that arise only from one peril or one type of peril, or which occur relative to a specific situation or location
Limited Perils
Limited Plans (2/2)
____ - while medical expense plans have moved quickly toward providing very high or unlimited benefits, the amounts paid by these plans are typically much smaller and often restricted to stated amounts; and
____ - to assure that insureds understand the limited nature of the coverage they are buying, states require these policies to contain a prominent notice on their first page stating that the coverage provides only limited benefits
Limited Benefits
Notice to Proposed Insured
____ policies only cover accidents as a peril and exclude any type of sickness or disease. The premiums are smaller than policies that cover both illness and injury. These policies may also pay a benefit if an accident results in dismemberment, disability, or death.
Accident-only policies
____ policies were originally developed to cover one type, of catastrophic illness specified in the policy such as cancer or heart disease. Today these policies may cover a number of life-threatening diseases or serious conditions including stroke, coma, live failure, kidney failure, and paralysis as well as the need for organ or bone marrow transplants. Some contain a health screening benefit to help with early diagnosis or catastrophic illnesses. These wider-ranging policies are sometimes called CRITICAL ILLNESS PLANS. One thing they all have in common is that benefits are strictly limited to those named in the policy.
Specified or Dread Disease Policies (Critical Illness)
____
These policies cover illnesses that are unlikely to affect everyone but are very expensive for those diagnosed with the condition. These specified policies are fairly inexpensive compared to comprehensive coverage.
Most policies may not pay the full cost of every treatment There may be no coverage for transportation or reimbursement for hospital room-and-board expenses may be limited to certain dollar amounts. Some of these policies simply pay a lump sum benefit upon diagnosis of a specified disease.
Specified or Dread Disease Policies (Critical Illness)
A Hospital ____, or Hospital ____, plan pays a flat dollar amount as a daily benefit for each day that the insured is hospitalized as an inpatient. The payment is made directly to the insured, not the hospital. These plans are not designed to reimburse the insured for the expenses of hospitalization but to provide income that the insured can use in any way they want. Individuals may use this kind of policy to meet the deductible and coinsurance payments on their medical expense policies or pay their other bills while they are in the hospital.
Hospital Income or Hospital Indemnity Plans
