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Chapter 9

Terms in this set (45)

health insurance
a form of protection that eases the financial burden people may experience as a result of illness or injury
group health insurance
employer sponsored plans that the employer offers and usually pays some or all of the premiums
basic health insurance coverage
includes hospital expense coverage, surgical expense coverage, and physician expense coverage
hospital expense coverage
pays for some or all of the daily costs of room and board during a hospital stay, routine nursing care, minor medical supplies, and the use of other hospital facilities are covered as well
surgical expense insurance
pays all or part of the surgeon's fees for an operation, whether it is done in a hospital or in the doctor's office
physician expense insurance
meets some or all the costs of physician care that do not involve surgery - covers treatment in a hospital, doctor's office, or patient's home
coinsurance
the percentage of the medical expenses the policyholder must pay in addition to the deductible amount
stop-loss
a provision that requires the policyholder to pay all costs up to a certain amount, after which the insurance company pays 100 percent of the remaining expenses as long as they are covered in the policy
hospital indemnity policies
pays benefits when hospitalized - paid in cash which you can spend on medical or nonmedical expenses as you choose
dental expense insurance
provides reimbursement for the expenses of dental services and supplies - encourages preventative dental care
long-term care insurance
provides coverage for the expense of daily help that you may need if you become seriously ill or disabled and are unable to care for yourself
major provisions in a health insurance policy
eligibility, assigned benefits, internal limits, copayment, service benefits, benefit limits, exclusions and limitations, guaranteed renewable, cancellation and termination
eligibility
the people covered by the policy must meet specified eligibility requirements
assigned benefits
you are reimbursed for payments when you turn in your bills and claim forms
copayment
a flat fee that you pay every time you recieve a covered service
benefit limits
defines a maximum benefit, either in terms of a dollar amount or in terms of number of days spent in the hospital
exclusions and limitations
specifies services that the policy does not cover
reimbursement policy
pays you back for actual expenses
indemnity policy
provides you with specific amounts, regardless of how much the actual expenses may be
internal limits
only covers a fixed amount for an expense
aggregate limits
limits only the total amount of coverage
coinsurance provision
states what percentage of the medical expenses the policyholder must pay in addition to the deductible amount
what sources can private health care plans be offered by
private insurance companies, hospital and medical service plans, health maintenance organizations, preferred provider organizations, home health care agencies, employer self-funded health plans
private insurance companies
provide mostly group plans to employers, which in turn offer them to their employees as a benefit
blue cross
provides hospital care benefits
blue shield
provides benefits for surgical and medical services performed by physicians
managed care
refers to prepaid health plans that provide comprehensive health care to their members
health maintenance organization
a health insurance plan that directly employs or contracts with selected physicians and other medical professionals to provide health care services in exchange for a fixed, prepaid monthly premium
supplemental services may include:
vision care and prescription services
preferred provider organizations
a group of doctors and hospitals that agree to provide specified medical services to members at prearranged fees - premiums are slightly higher than HMOs and members often pay no deductibles and make minimal copayments
point-of-service plan
combines features of both HMOs and PPOs - uses a network of participating physicians and medical professionals who have contracted to provide services for certain fees
flexible spending accounts
allow you to contribute pretax dollars to an account managed by your employer - use the money for health care spending but forfeit anything leftover at the end of the year
health reimbursement accounts
tied to high-deductible policies, funded solely by your employer and gives you a pot of money to spend on health care - can carry over unspent money from year to year but lose the balance if you switch jobs - premiums tend to be lower than traditional insurance but higher than for HSAs
health savings account
allow you to contribute to a tax-free account that can be used for out-of-pocket health care expenses if you buy high-deductible health insurance policies to cover catastrophic expenses
medicare
a federally funded health insurance program available mainly to people over 65 and to people with disabilities
Part A of medicare
hospital insurance - helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care
Part B of medicare
medical insurance - helps pay for doctors' services and a variety of other medical services and supplies - has a deductible and a 20% coinsurance provision
Part C of medicare
combines hospital and medical
Part D of medicare
prescription drug coverage
medigap policy
medicare supplement insurance by filing the gap between medicare payments and medical costs not covered by medicare
what is NOT covered by medicare
certain types of skilled or long-term nursing care, out-of-hospital prescription drugs, routine checkups, dental care, and most immunizations
disability income insurance
provides regular cash income when you are unable to work because of a pregnancy, non-work-related accident, or an illness
you should aim for a benefit amount that, when added to other sources of income, will equal ________ percent of your take-home pay
70-80
factors that add up to rising health costs
aging and overweight population, cost of prescription drugs, growing number of uninsured, advancements in medical technology
what two third parties pay a large part of the nation's health care bill
private health insurers and the government
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