Unit 33: Special Types of Health Policies

Question 1

Most dental policies are what?

Answer 1

comprehensive policies that work much the same way as comprehensive medical expense coverage

Question 2

Some dental policies are scheduled, which means what in regards to benefits? Pg 474

Answer 2

They are limited to specified maximums per procedure, with first dollar coverage.

Question 3

Comprehensive dental plans usually provide what in regard to coverage? how do deductibles come into play?

Answer 3

they provide routine dental care services without deductibles or coinsurance to encourage preventitive dental care

Textbook: Generally there is a specified maximum dollar amount payable per year, and sometimes, per family member covered

Question 4

Subject: Dental Care Question: for non routine treatments, a comprehensive policy pays what (regarding the charges)? what does the patient pay?

Answer 4

the comprehensive policy pays a percentage of the reasonable and customary charges. the patient pays an annual deductible and whatever expense remains

Question 5

What is the vertical dimension, splinting, and restoring occlusion exclusion?

Answer 5

limits liability for exotic and highly optional procedures

Question 6

How does an insurer often reduce its liability for payment of dental expenses by contractual provisions?

Answer 6

they state what a plan does cover and what it will not cover

Question 7

What is the 5 year replacement exclusion?

Answer 7

this exclusion pertains to not allowing replacement of prosthetic appliances (such as retainers or spacers) for 5 years after benefit is paid

Question 8

what are exclusions and limitations from the dental care coverage? 5 things

Answer 8

1. Cosmetic exclusion
2. missing tooth provision
3. 5 year replacement exclusion
4. vertical dimension, splinting, and restoring occlusion exclusion
5. expenses for oral hygiene instructions and plaque control programs are often limited or excluded

Question 9

what is the cosmetic exclusion?

Answer 9

this exclusion says that benefits are not payable for dental work that is not necessary to have good teeth. extravigant stuff is not needed. anything out of what is required to have good teeth is not covered

Question 10

what is the missing tooth provision (remember provisions protect the company as well so it would be something they do not want to cover)?

Answer 10

excludes coverage for teeth that are missing when the coverage becomes effective

Question 11

What is hospital income or hospital indemnity coverage? (think literally terms)

Answer 11

a policy that pays a specific amount of insurance for each day an individual is hospitalized

Question 12

What are dread policies and what do they do?

Answer 12

they are policies that protect you if a dread diseases occurs but they are policies you can buy to cover specific diseases that are named in the policy such as heart disease or cancer

Question 13

What are dread diseases? What is the cost related to them?

Answer 13

diseases that are “dreadful” and do not occur frequently. They are very expensive to

Question 14

What is the rule on oral hygiene instructions and plaque control when it comes to what is covered or not?

Answer 14

these programs are often limited and excluded

Question 15

who gets paid in the hospital income or hospital indemnity coverage?

Answer 15

the insured not the hospital

Question 16

What is the intention of hospital income or hospital indemnity policies?

Answer 16

They are note dsigned to cover expenses for being in the hospital but rather are designed to give an insured a flow of income that begins when the insured is confined to the hospital and ends on the final day of hospitalization

Question 17

What do some people do with the hospital income or hospital indemnity that comes from the policy that as the same name

Answer 17

some insureds may use that money to meet deductibles and coinsurance requirements of their medical expense policy

Question 18

Although basic, comprehensive, and major medical policies often cover disease and injury to the eyes, there is generally no what?

Answer 18

coverage for eye exams and corrections such as eye glasses or contact lenses

Question 19

how do insurers clsoe the gap where coverage for eye exams and corrections such as eye glasses or contact lenses are not covered?

Answer 19

they may over vision care policies

Question 20

What is the purpose of long term care (LTC policies)

Answer 20

There was an increase in the number of benefits of long-term care insurance policies, they designed to cover many of the expenses associated with residence in and out of hospital facilities

Question 21

With the federal government responding to consumer interests in long term care (LTC) coverages, the National association of Insurance commissioners (NAIC) developed a model to help state legislatures in an effort to keep regulation on a sate level. More than half ot the states currently use the NAIC model. What are the two key issues it covers?

Answer 21

1. a benefit period of at least one year
2. strict restrictions on cancellation, specifically prohibiting cancellation because of the insured’s aging - most policies now guarantee renewability

Question 22

How are LTC polices different than other health plans?

Answer 22

they are rated differently snd they use a different means of classification determine whether or not somebody is a standard risk

Question 23

What is the determining factor for LTC policies if they are going to ensure someone?

Answer 23

The key is whether or not an individual can perform activities of daily living with a degree of proficiency

Question 24

What are the activities of daily living (ADL’s)?

Answer 24

Dressing, bathing, eating, walking, and similar activities

Question 25

IS an individual with heart disease who is still able to perform ADLs insurable?

Answer 25

yes they are. they are a standard risk whereas for other policies they would be a substandard risk

Question 26

What are the 3 terms that are important to know when it comes to LTC policies to know what they cover?

Answer 26

1. Skilled nursing care (skilled medical people, doctor's orders, daily) 2. Intermediate care (skilled medical people, doctor's orders, occasionally) 3. Custodial or residential care (help in performing ADLS by someone without skills or training, need doctor's orders) They're all one based on the doctors orders, two vary in timing, and first two can be skilled whereas last one doesn't need to be

Question 27

What is skilled nursing care, that is covered by LTC policies and how often is it covered?

Answer 27

nursing and rehab care can only be performed by skilled medical practitioners on the doctors order. DAILY

Question 28

What is intermediate care, that is covered by LTC policies and how often is it covered?

Answer 28

Nursing and rehab care that is required and can only be performed by skilled medical practitioners on the doctors orders. OCCASIONALLY

Question 29

What is custodial, residential care, that is covered by LTC policies and how often is it covered?

Answer 29

Helping performing activities of daily living by someone without medical skills or training, but it has to be based on the doctors order

Question 30

What does home health care in regards to LTC policies?

Answer 30

Services performed from TIME TO TIME in individuals home. It may include skilled nursing, various types of therapy, help with ADLs, come and help with housework. MUST OFFER IN KY

Question 31

What does Adult day care in regards to LTC policies?

Answer 31

Adult daycare provides company, supervision, social, and recreational support during the day for people who live at home and need assistance. The service is especially useful, for those are being cared for by relatives who work during the day. The difference between this and home health care is that this is more frequent

Question 32

What is the youngest and oldest ages at which LTC policies may be purchased provision?

Answer 32

The age in which these policies may be purchased is different because now, instead of the minimum age being between 50 and 60 years old, you know I'm a purchase one as low as 18 years old. And now you may buy one anywhere in the age range of 69 years old to 89 years old.

Question 33

What are the 6 provisions connected with LTC policies

Answer 33

1. Youngest and oldest ages at which LTC policies may be purchased 2. Waiver of premium 3. Prior Hospitalization 4. Home Health Care 5. Adult Day Care 6. Inflation protection

Question 34

What is the waiver of premium provision in LTC policies? When does care start again?

Answer 34

Almost all LTC policies include the waiver of premium provision after the insured has been confined and in care for a certain number of days. In most cases, the certain number of days is 90 but it can be as long as 180 days and some policies. Premium payment start back up once Carol is done

Question 35

What is the prior hospitalization provision and LTC policies?

Answer 35

Most nursing home policies required a person to be in the hospital prior to confinement to a nursing home in order for the benefits to be paid, but that no longer is the case

Question 36

What is the home healthcare provisioning LTC policies?

Answer 36

Most LTC policies now cover home health care as an alternative to nursing home care

Question 37

What is the adult, daycare provision in LTC policies? protects the worker

Answer 37

This allows a primary caregiver who works opportunity to tend to his appointment responsibilities.

Question 38

What is the inflation provision? How do you get this provision? (think premium)MUST OFFER IN KY

Answer 38

For an additional premium amount, LTC policies, offer, automatic percentage increases and benefits every year, or as an alternative, periodic opportunities to purchase a higher level of benefits, without evidence of insurability

Question 39

How do large insurance companies market LTC coverage?

Answer 39

They use a third marketing device which involves attaching an LTC rider to a life insurance policy, called "accelerated benefits, writer" or "living benefit rider"

Question 40

What is credit insurance? What is the purpose of credit insurance? pg 483 + 484

Answer 40

It is insurance that covers the company who has an insurance who owes them money Text: Credit health insurance covers a debtor with a creditor, receiving the benefits to pay off the debt if the debtor is disabled or dies accidentally. What does means is that when the person I was the death dies the person who ultimately want to pay them at the end of the day is taken care of. The purpose of credit insurance is there, and share that the outstanding indebtedness will be paid if the insured is disabled, or does accidentally before the loan is repaid. The accidental death benefit may not exceed the total amount of indebtedness at any given point, nor may the monthly disability benefit exceed them out of the monthly payment on the loan.

Question 41

What is the minimum number of debtors a creditor must have per year before it qualifies for Group credit insurance?

Answer 41

100

Question 42

Does credit health insurance cover a debtor if he dies a natural death? What would cover them?

Answer 42

no, credit life insurance

Question 43

What is credit life insurance?

Answer 43

This will pay death benefits, whether or not death occurs by accident or naturally. This is not considered health insurance because it provides for natural death, benefits, whereas health insurance covers only accidental death

Question 44

Who is the beneficiary in credit life insurance?

Answer 44

Whether individual or group coverage, the creditor is the beneficiary of the policy