Types of Health Policies Flashcards
(30 cards)
In what type of health plans are providers paid for services in advance, regardless of the services provided?
Prepaid Plans
What are the three types of basic medical expense insurance?
Hospital, Surgical, Medical
What do individual insureds receive as proof of their group health coverage?
Certificate of Insurance
What is the main principle of an HMO plan?
Preventive care
Under what type of care do insurers negotiate contracts with health care providers to allow subscribers access to health care at a favorable cost?
Preferred Provider Organization (PPO)
How are HMO territories typically divided?
Geographic areas
Who are the parties in a group health contract?
The employee and the insurer
What is the capital sum in Accidental Death and Dismemberment (AD&D) coverage?
A percentage of the principal sum
What does the amount of disability benefit that an insured can receive depend on?
The insured’s income at the time of policy application
Why do HMOs encourage members to get regular check ups?
To help catch health problems early when treatment has the greatest chance of success (preventive care)
In health insurance, what is considered a sickness?
An illness that first arises while the policy is in force
What type of hospital policy pays a fixed amount each day that the insured is in the hospital?
Hospital indemnity
What type of injuries and services will be excluded from major medical coverage?
Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care, custodial care, and cosmetic surgery
What is a fee-for-service health plan?
Under a fee-for-service plan, providers receive payments for each service provided
How can an HMO member see a specialist?
Referral by the primary care physician
Who chooses a primary care physician in an HMO plan?
The individual member
What is the purpose of respite care in long-term care insurance?
To provide relief for a major caregiver (usually a family member)
With key person disability insurance, who pays the policy premiums?
The business (employer)
What are the two types of flexible spending accounts?
Health care accounts and dependent care accounts
What is the purpose of COBRA?
To allow continuation of health coverage for terminated employees (up to 18 months)
What type of health insurance would pay for hiring replacement for an important employee who becomes disabled?
Key-persons disability insurance
What is the purpose of a buy-sell agreement for health insurance policies?
To specify how the business will pass between owners when one of them dies or becomes disabled
Can an insured who belongs to a POS plan use an out-of-network physician?
Yes, but the copays and deductibles may be higher
Can Alzheimer’s disease be excluded from coverage under a long-term care policy?
No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered
