Insurance Flashcards
(59 cards)
What percentage does healthcare make up in the GDP?
16%
What is Health Insurance?
A contract between a patient and insurance carrier.
What is an Insurance Carrier?
A company which provides insurance plans which protect the patient against financial loss when in need of health service.
When was health insurance developed?
1920s
What agreement maybe held between an insurance carrier and patient?
If the patient is in need of a health service the insurance carrier will pay a portion of the cost including treating patients with illness, injuries, testing, routine exams, and medications.
How can you enter an insurance contract?
The patient must pay a premium which is like a membership fee to be enrolled in an insurance plan. Usually paid on a monthly basis.
What is the patient entering the contract called?
The Insured
If the members are under the same policy, they are called ________ and the insured must pay higher premiums and deductibles.
The Beneficiaries
Patient must pay this themselves_____
out-of-pocket
Out-of-Pocket can include:
Deductibles
Exclusions (Copayment)
Coinsurance
What is a deductible?
A fixed amount of money the patient must pay before the insurance carrier begins to pay for the benefits. This must be paid yearly.
What is coinsurance?
A fixed insurance that takes responsibility for 80 percent of the cost and the patient pays 20 percent.
What is copayment?
The fee collected at the time of service. This will always remain the same unlike coinsurance.
What is Group Insurance and how is it purchased?
Group insurance is commonly purchased through an employer and the employer pays a portion of the premium. Group Insurance is almost always less cheaper than individual insurance.
What is individual insurance and how is it purchased?
Individual Insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage, while this is the more expensive option this allows more choices in the type of benefits a person gets. Patients can purchase the best coverage suitable for their needs.
What is the Affordable Care Act and how can it impact people?
The Affordable Care Act has opened up more options for individuals to purchase individual insurance through a healthcare marketplace at an affordable price.
If an individual is enrolled in an insurance plan through a benefits package at work, what kind of enrollment is this?
Group Insurance
What is one advantage of individual enrollment over group enrollment in an insurance plan?
More choice of policies
What are the types of funding’s?
Private and Public
Private Insurance
- Private funding comes from enrollees, those who are enrolled in the insurance plan.
- Anyone can enroll in a privately funded program.
- Costs and Coverage will vary widely
- Two types of insurance: Fee-for-service and Managed care.
Public Insurance
- Public funding comes from state to federal governments
- To enroll in public programs, a person will have to meet certain restrictions. These restrictions vary depending on the type of program.
Fee-for-service
Maybe referred as an indemnity pIan or traditional insurance. In early years of health insurance, most policies were fee-for-service plans where patients often pay healthcare costs out-of-pocket. Then they are reimbursed by the carrier for their expenses.
Managed care
Some people cannot afford out-of-pocket and wait for reimbursement, as a result a new type of medical insurance became popular in the 1970s. Managed care is built onto two concepts: to promote good health and to practice preventative medicine.
HMO model that hires physicians directly.
Staff Model
