Individual Health Products Flashcards
1
Q
Individual Health Products
Insurer Considerations when Choosing Providers for Network
A
- How restrictive network will be
- Practice patterns (Quality, Efficiency, adherence to treatment standards)
- Cost
2
Q
Individual Health Products
Hospital Indemnity Plans
A
Pays flat amount per day of IP hospitalization
- Intended to supplement major medical, not replace it
3
Q
Individual Health Products
Medicare Supplement Plans
A
Covers gap in Medicare coverage, including coinsurance and deductible
4
Q
Individual Health Products
Regulations that Impact Medicare Supplement Plans (List and Define)
A
- NAIC Medicare Supplement Insurance Minimum Standard Models Act = Defines benefit designs
- Balanced Budget Act = High-Deductible plan
- Medicare Improvements for Patients and Providers Act = Introduced/removed plans
5
Q
Individual Health Products
Medicare Advantage Enrollment
A
- Initial Enrollment
- Annual Open Enrollment (Oct 15 - Dec 7)
- Special Enrollment
6
Q
Individual Health Products
Medicare Advantage Bid Process
A
- Advance Notice
- Announcement
- Sponsor submits bid (First Monday in June)
- Desk Review (July)
- Rebate Reallocation (Early August)
- Second actuarial certification
- Bids are approved
7
Q
Individual Health Products
ACA Impact on Medicare Advantage
A
- Focus = controlling spending increase and improving quality of care
- MLR = 85%
- Coverage gap in Part D to be closed by 2020
8
Q
Individual Health Products
Categories of Renewability for Disability Coverage
A
- Non-Cancelable (Renew with same rates)
- Guaranteed Renewable (Renew, but changing rates)
- Conditional Renewable
9
Q
Individual Health Products
Business Protection Coverages
A
- Key Person Coverage
- Disability Buyout Coverage
- Business Overhead Expense
