Hl Flashcards
Injured (158 cards)
1
Q
Offers comprehensive prepaid health care services its subscribing
A
Hmo
2
Q
Subscribers pay a fixed periodic fee
A
Hmo
3
Q
Pays a fixed periodic fee
A
Hmo
4
Q
What is a hmo
A
Health maintenance organization
5
Q
Payment given to physician is called
A
Capitation
6
Q
Stressing preventive care
A
Hmo
7
Q
Self funded based on dues or fees from their subscribers contact excess insurance
A
Hmo
8
Q
Employers with 25 or more
A
Hmo
9
Q
What is a ppo
A
Preferred provider organization
10
Q
Collection of health care providers at prearranged discounts
A
Ppo
11
Q
Fee for service rendered
A
PPO
12
Q
Fee for service rendered
A
PPO
13
Q
Specialize in one or more types of medical expenses and disability income insurance
A
Commercial insures
● Life insurance
● casualty
● monoline
14
Q
Functions on the reimbursement apporach
A
Life insurance
Casualty
Monoline
15
Q
Let’s policyholders assign benefits payments from insurer directly to health care providers
A
Assignment
16
Q
What relieves the policy owners of first having to pay the medical care providers
A
Assignment
17
Q
Delivers health services at its own local health care facilities subscribers
A
HMO
18
Q
pay a fixed periodic fee
A
HMO
19
Q
Physician that work out of the HMO facility
A
CLOSED PANEL
20
Q
Physician who work out of their own facilities participate in hmo part time
A
HMO IPA
21
Q
requre subscribers to select a primary care
A
HMO
22
Q
Groups at prearranged discount prices
A
PPO
23
Q
made in 1966 provide hospital and medical expense
A
MEDICARE
24
Q
What’s part A
A
drug administration Insured enters a hospital benefit 100 days period in a skilled nursing 1-20% 21-100 flat dollar amount per day 190 days inpatient psychiatric Primary source of financing federal payroll self employment taxes
25
Jan1 mar31 funded by General tax revenue and user premiums
Part B
26
Covers inpatient hospital stay
PART A
27
Financial protection against the cost of medical care for accidents and illness
MEI
28
Excludes cove6 for care provided in a government facility written for a term of 1 yr
MEI
29
First dollar insurance
BMEP
30
Covers hospital room and board miscellaneous expenses
Part A
31
Expenses are covered while the insured is confined in a hospital
PART A
32
No deductible room board are set specified dollar amount per day up to # days
PART A
33
Utilization review that takes place on site length of stay in the hospital
Concurrent review
34
testing reducing length of hospitalization
Peradmission
35
Pays service is performed in or out of hospital
Basic surgical expense
36
Surgeon fee anestigist operating room
Basic surgical expense
37
Assigned a dollar amount by the insurer
Surgical schedule
38
Paid in full surgical expenses compared to what is deemed reasonable
Reasonable customary
39
Charges are the maximum amount the insurer will consider eligible for reimbursement
Usual customary reasonable UCR
40
Set of units is aggigned dollar per units conversion factor to determine the benefit
Relative value approach
41
Covers er accidents benefits offer only limited benefits they're subject to
time limitations
Basic physician expense coverage
42
Supplement to a basic plan or as a comprehensive stand alone plan
Major medical expense
43
Benefits are 1 yr
Carry deductible coinsurance requirements
Have large benefits maximum
Covers inpatient and outpatient hospital expenses
Major medical expenses
44
Pain management home based services counseling hospice benefits
Major medical expenses
45
Lists if drugs covered by a pharmacy
Drug formulary
46
Initial stated dollar amount
Flat
47
Covers the gap between basic coverage and major medical
Corridor
48
Major medical plan is supplementing basic coverage
Integrated
49
Insured must satisfy a deductible for each accidental or illness
Per cause deductible
50
Insured only has to meet the deductible amount once during the benefit period
All cause deductible
51
Deductible begins January 1st ends dec31st insured must pay a specific
Sum out of pocket before any benefits are paid in a yr
Calendar year deductible
52
Permission expenses incurred during the 3 last 3 months
| carried over into a new year to satisfy deductible for next year
Carry over
53
One deductible need be satisfied when 2 or more insured same
Family are injured in same accidents same illness
Common accident or sickness
54
Waives the deductible for family members after some deductible have been paid same year
Family maximum
55
Sharing of expenses by the insured and the insurer
COINSURANCE
56
Percentage of payment
Insured is 20%
| Insurance companies 80%
57
Limits the amount of expenses the insured may be exposed to in a year
Stop loss
58
Taxable 20% penalty distribution
HSA
59
Tax advantage reimburse employees for out of pocket medical expenses and individuals
Health premiums
Health reimbursement arrangements HRA
60
Unused amounts maybe carried forward for reimbursement in future yrs
Hra
61
Reimbursement tax free qualified medical expenses or qualified
Medical plan
Hra
62
Employees don't contribute to an
HRA
63
Small employers pay for their medical care expenses self employed
Medical saving account MSA
64
Individuals tax free account for employers 50 employees
MSA
65
Tax advantage accounts set up through a cafeteria plan of a employer
FSA
66
Allows an employee to set aside a portion of earnings to pay for qualified medical
Expenses established in the cafeteria plan
FSA
67
Disability defined
Insured must be totally disabled before benefits
under a disability income policy are payable
considers the insureds education,training,experience
68
To receive disability income benefits the insured must be unable
To work at the insured own occupation
Own occupation OC
69
Insured must be unable to perform any job for which
The insured is reasonably suited by reason of education
Training
Any occupation AO
70
Reduces or eliminate the insured ability to work
For the rest of the insured life without expectations
Of recovery
Permanent disability
71
Activities not limited to caring for oneself
| Manual tasks
Americans with disabilities act ADA
72
Can't perform the insured current occupation as a
| Result of an accident or sickness
Own occupation
73
Less restrictive than any occupation
OC
74
Long term disability policy use okc clause for 1st 2 to 5
| Of disability after provide benefits under an oc
Own occupation
75
Unable to perform any occupation
Any occupation
76
Policy that don't cover losses due to hazardous occupation
Nonoccupation
77
Automatically gives insured fit full benefits because
The severity conditions presumes insured is totally disabled
Even if you are able to work
Presumptive disability
78
Can't perform one or more important duties
| Of the job can't work full-time which results in decrease income
Partially disability
79
Applies to accident and illness disability
Pd
80
Disability resulting from one accident
Pd
81
Encourage disability to get back to work
Pd
82
Payable only if totally disabled
Pd
83
Insured collect 50% of the monthly income for
| 3 months or a 6 month
Pd
84
Amount of benefits payable depends on policy stipulates
| A flat amount or residual amount
Pd
85
Disability caused by accident or illness
Illness will be coverage unless restricted
By a pre existing conditioners or policy limitation
Injury or accident vs sickness disability
86
Injury must have been unexpectedl and accidental
Injury or accident
87
Result of injury has to be unexpected and accidental
Sickness disability
88
Totally disabled due to accident and illness
| Only collect loss of income due to accident or sickness
Injury accident sickness
89
Disability that occurs later amount allowed
| Is 20 30 60 90 days
Delayed disability
90
Spec a period of time during recurrent of a disability
| Is considered a continuous of prior disability
Recurrent disability
91
90 or 6 month benefits without new policy
| After that period it's a new disability
Recurrent disability
92
Subject to a new elimination period before benefits are
| Again payable
Recurrent disability
93
Injury that doesn't qualify for income benefits
Nondisabling injury
94
Must provide a proof of treatment
Nondisabling disability
95
Insured to stay indoor
Confining
96
Isn't required to stay indoor
Nonconfined
97
Benefits paid under a disability income
| Policy are in the form of monthly income payments
Disability income benefits
98
A ceiling on the amount odes disability income protection they'll
Issue on any one applicant based on the insured income at the
Time of purchase
Disability income benefits
99
Compared to the insured previous earnings the benefits provided
Under di6 income insurance should be somewhat less to avoid
Over insurance
Disability income benefits
100
Percent of earnings approach which determines the benefits amount
By using a percentage of the insured pre disability earnings take into account
Other sources of disability income
First method
101
Flat amount method benefits amount if insured
Is totally disabled payable regardless of income
Received
Second method
102
Set amount benefits stated in the policy
Flat amount benefits
103
Amount is usually 50% of the full disability benefits
Flat amount benefits
104
Based on the proportion of income actually
Lost due to the partial disabilities taking into account
The fact that the insured is able to work
And earn some income
Residual disability amount benefits
105
Partial and residual disability riders may not be added to the same policy
Residual disability amount benefits
106
Benefits is usually determined by multiplying the percentage of lost
Income by the stated monthly benefits for total disability %x monthly
Income
Residual disability amount benefits
107
Gives training to prepare insured for a new occupation
Rehabilitation benefits
108
Insured pays benefits as long as the insured remain
| Totally disabled and active in the program
Rehabilitation benefits
109
Benefits of 1% of the face amount of the policy
| Which is payable if the insured is totally disabled
Disability benefits in a life insurance contact
110
Determine if an income loss has act6 occurred
Loss of earnings test
111
Short term income provide for an optional lump sum payment
Rather than receiving a peri9 payments for certain injury
Elective indemnity
112
Short term riders benefits during the first 6 to 12 months of a disability
Additional monthly benefits Amb
113
Waives the elimination period while the insured is con6 to a hospital
Hospital confinement rider
114
Purchase to help make loan payments if the insured were
| To ever become disabled pay the monthly payment
Credit disability
115
Guaranteed renewable noncancellable exempts
The policyowner from paying the polices
Premiums during period total disability
Waiver of premium rider
116
Must be totally disabled for 3 or 6 months
Premiums are waived beginning at date of
Disability doesn't extend past 60 or 65
Waiver of premium rider
117
Subject to income tax
Social security rider
118
Extends the benefits period beyond age 65
If insured is totally disabled as result of a injury
Or illness
Lifetime extensions rider
119
Indexing the monthly or weekly benefits payable
| Under a disability policy to changes in the consumer price
Cost of living adjustments COLA
120
Benefits amount is adjusted on each disability anniversary date to
Reflect changes CPI
Cost of living adjustments COLA
121
Guaranteed the insured the right to periodically increase
The amount of benefits payable without evidence
Insurability
GUARANTEED INSURABILITY RIDER
122
Future increase or income option
GUARANTEED INSURABILITY RIDER
123
Time that must elapse following the effective
| Date of the policy before benef6 are payable
PROBATIONARY PERIOD
124
Time immediately following the start of a disability
| When benefits are not payable
Elimination period
125
Time based deductible in a disability income policy
Elimination period
126
Disability income policy include a day eliminate period
30 day
127
Eliminate claims for short term disability
Elimination period
128
Lowers the premium for comparable disability benefits
Longer elimination period
129
Waiting period
Elimination period
130
Maximum length of tine that disability income benefits will be paid to the disabled
Insured
Benefits period
131
Higher the cost of the policy
Longer the benefits period
132
Rather than charge additional premiums or exclude
| Coverages
Benefits period
133
6 to 2 yrs benefits
Benefits period
134
Individual long term polices pay benefits periods
| Of more than 2yrs 5 10 20 yrs to age 65
Benefits period
135
Shirt term disability benefits policy are paid weekly
Benefits amount
136
Long term disability benefits are paid monthly
| With a maximum benefits limit
Benefits amount
137
Amounts are limited to encourage disabled
| Individuals to return to work
Benefits amount
138
Actively working for a stated number of hrs per with
| If coverage extends past age 65
Coverage after 65 provisions
139
Injured in a hazard occupation stated in policy
Change of occupation provision
140
Benefits levels are reduced
Change of occupation provision
141
Engaged in less hazardous occupation then originally stated
In policy benefits will likely be increased
Change of occupation provision
142
Refund provision for a insured for a % of all premiums
| Paid certain period
Return of premium provision
143
Returns alk premiums to policyowner at age 65
CASH SURRENDER VALUE RIDER
144
Exclude losses arising from war military service attempted
| Suicide overseas residence
Disability exclusion
145
Savings
Borrowing money from others
Depending on a partners income
Liquidate assets
ALTER9 DISABILITY INCOME
146
Life insurance pension or profit sharing plans vacation pay deferred
Compensation arrangements funeral sicktime
Employee benefit plans
147
Business owner becomes disabled individual
Business overhead expense
148
Rent or mortgage utilities telephone leased equipment
| Employee salaries taxable income
Business overhead expenses insurance
149
Selling and buying a PARTNERS or stock owners share of a business
In the event of DISABILITY funded disability income policy paid
To company or another shareholder
DISABILITY BUY SELL PLANS
150
Benefits in the form if periodic pay9
Lump sum payments tax free
Lengthy elimination periods 2 yrs
Disability buy SELL plans
151
Monthly benefits to the business owner is totally disabled
To specifically payoff a loan or another fi9 obligation
Reducing term insurance
152
Paya9 only for the remaining period of time of the outstanding debt
Reducing term insurance
153
Policy owned by business insured is the owner not tax deductible
Tax free monthly benefits
Reducing term insurance
154
Monthly benefits to a business covers expenses for additional help or outside services
Key person
155
Disabled person policy elimination period will be
| 30 to 90 days benefits period 1 or 2 yrs tax free
KEY PERSON
156
Premiums paid are fully deductible not income taxable
Sole proprietors
157
Premiums paid are tax deductible to partnerships
| Paid by partnership not income taxable
PARTNERSHIPS
158
Premiums paid are tax deductible and benefits receives
| Not income taxable
LLC
