Required Knowledge Flashcards
(36 cards)
What is health insurance?
Health insurance is a contract between a consumer and a health insurance company* that requires the insurance company to pay or reimburse some or all of a consumer’s health care costs when he or she gets sick or needs medical care. A consumer is required to pay a fixed monthly amount as part of the contract.
What 7 counties do we serve?
Cumberland, Salem, Camden, Burlington, Cape May, Atlantic, Gloucester
What is a premium?
A consumer is required to pay a fixed monthly amount as part of the contract.
More about health insurance
When consumers have insurance, they pay some costs and, the insurance company pays some costs.
Health insurance provider network
Health insurance companies contract with certain hospitals, doctors, pharmacies, and other health care providers to deliver medical services for an agreed upon rate
Why do consumers need health insurance?
Health insurance allows consumers to get preventive health care
services to help them stay healthy.
• Health insurance helps pay for health care services if a consumer
becomes sick or injured.
• Without health insurance, costs for health services can be extremely
high and may result in serious financial hardship.
• The Affordable Care Act requires consumers to have health insurance
or pay a fee.
What is managed care?
Managed care is a way for insurance companies to manage the cost, quality, and access to health care services.
What is the Affordable Care Act?
Congress enacted the Patient Protection and Affordable Care Act on March 23, 2010, and the Health Care and Education Reconciliation Act on March 31, 2010. Together, these two laws are referred to as the Affordable Care Act.The Affordable Care Act gives consumers the tools they need to make informed choices about their health coverage.
What are the major features of the health care law that apply to consumers?
• Access to certain free preventive services
• Health coverage for pre-existing conditions
• Access to health coverage through the Marketplace, with open
enrollment beginning October 1, 2013, and coverage beginning as soon
as January 1, 2014
• Health coverage for young adults up to age 26 on their parents’ health
plan, if the plan covers dependents
If I don’t have coverage?
If someone who can afford health insurance doesn’t have coverage in 2014, they may have to pay a fee. They will also have to pay for all of their health care.
What are major features of the health care law that apply to MOST health insurance companies?
- Helping consumers understand their health coverage benefits and financial responsibilities
- Refraining from cancelling health coverage after they’ve already agreed to cover consumers
- Offering certified health plans
- Offering a guaranteed set of benefits
- Prohibiting lifetime limits on coverage
How does the Affordable Care Act increases access to health coverage for consumers?
ACA offers
• Access to certain free preventive services
• Health coverage for pre-existing conditions
• Access to health coverage through the Marketplace
• Health coverage for young adults up to age 26 on their parents’ health
plan, if the plan covers dependents
How has the ACA changed the way we access preventive services?
Previously, consumers were responsible for copayments to receive common preventive services. Most health plans, both inside and outside of the Marketplace, are now required to cover preventive services such as annual physicals, vaccines, and mammograms at no cost to when the services are delivered by in-network providers.
How has the ACA assist consumers with health coverage for pre-existing conditions?
Previously, health insurance companies could deny health coverage to consumers with pre-existing health conditions. A pre-existing condition is a health problem consumers had before the date that their health coverage started. The Affordable Care Act now guarantees that all eligible consumers, including those with pre- existing conditions (e.g., diabetes or cancer), can get health coverage.
What is considered minimum coverage?
Healthcare.gov
Any Marketplace plan, or any individual insurance plan you already have
Any employer plan (including COBRA), with or without “grandfathered” status. This includes retiree plans
Medicare
Medicaid
The Children’s Health Insurance Program (CHIP)
TRICARE (for current service members and military retirees, their families, and survivors)
Veterans health care programs (including the Veterans Health Care Program, VA Civilian Health and Medical Program (CHAMPVA), and Spina Bifida Health Care Benefits Program)
Peace Corps Volunteer plans
Other plans may also qualify. Ask your health coverage provider.
What kinds of health insurance don’t qualify as coverage?
Healthcare.gov
Health plans that don’t meet minimum essential coverage don’t qualify as coverage in 2014. If you have only these types of coverage, you may have to pay the fee. Examples include:
coverage only for vision care or dental care
workers’ compensation
coverage only for a specific disease or condition
plans that offer only discounts on medical services
Can I get dental coverage in the Marketplace?
Healthcare.gov
Health plans that include dental coverage. In the Marketplace, dental coverage will be included in some health plans. You’ll be able to see which plans include dental coverage when you compare them. You’ll also see what the dental benefits are. If a health plan includes dental coverage, you will pay one premium for everything. The premium shown for the plan includes both health and dental coverage.
Separate, stand-alone dental plans. In some cases separate, stand-alone plans will be offered. You may want to choose this option if the health coverage you plan to enroll in doesn’t include dental coverage, or if you want different dental coverage.
How do I get an exemption?
Healthcare.gov
For religious conscience and hardship exemptions, you complete an application in the Health Insurance Marketplace and indicate that you want an exemption. Most other exemptions are claimed on your federal income tax form. Information about these procedures will be available after open enrollment begins.
What is another name for the Health Insurance Marketplace?
healthcare.gov
health insurance exchange
What are the three ways one can apply for Marketplace coverage?
healthcare.gov
Online, by mail or in-person with the assistance of a Navigator or other qualified helper. Telephone help and online chat are available 24/7 to help you complete your application.
When does open enrollment end?
healthcare.gov
March 31, 2014
How does the Marketplace present plan information?
healthcare.gov
It gathers the options available in your area in one place. It allows you to compare plans based on price, benefits and other features important to you before you make choice.
What are the four categories that plans are presented in?
healthcare.gov
Bronze, Silver, Gold and Platinum
What if I need coverage that starts before January 2014?
healthcare.gov
You can buy individual insurance that starts before January 1, 2014. But some rights and benefits won’t apply yet.
