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Chap 15-5
n/a
89
Finance
Undergraduate 4
12/07/2011

Additional Finance Flashcards

 


 

Cards

Term
major medical policies have what on the amounts paid for certain services that may apply each year, or there may be lifetime (aggregate) limits
Definition
internal limits
Term
examples include limits on home health care, hospice care, treatment for alcoholism and drug addiction, routine physical exams, and care in a skilled nursing facility
Definition
internal limits
Term
most individual major medical plans have incorporated elements of managed care in the
Definition
plan design
Term
a generic term for medical expense plans that provide benefits to insureds in a cost effective manner
Definition
managed care
Term
physicians, hospitals, and other health-care providers who are part of a plan network and agree to provide medical services to plan members at discounted fees
Definition
preferred providers
Term
insured who are out of the network for care must pay higher out-of-pocket costs for the care received w/
Definition
preferred providers
Term
allows all eligible persons under the age of 65 to establish health savings accounts an receive
Definition
favorable income-tax treatment
Term
a tax-exempt or custodial account established exclusively for the purpose of paying qualified medical expenses of the account beneficiary who is covered under a high-deductible health insurance plan
Definition
health savings account (HSA)
Term
a high-deductible health insurance policy that covers catastrophic events, and an investment account from which the account holder can withdraw money tax-free for medical costs
Definition
two components of HSA
Term
you must be covered by a high-deductible health plan and must not be covered by any other comprehensive health plan that is not a qualified high-deductible plan
Definition
eligibility requirement of HSA
Term
you must not be eligible for medicare
Definition
eligibility requirement of HSA
Term
you must not be claimed as a dependent on another person's tax return
Definition
eligibility requirement of HSA
Term
insured who are out of the network for care must pay higher out-of-pocket costs for the care received w/
Definition
preferred providers
Term
the patient must require care in skilled nursing facility, and only up to 100 days are covered and custodial care is excluded all together
Definition
medicare programs
Term
most elderly are not eligible for long-term care under the
Definition
medicaid program
Term
most sold today are tax-qualified, which meet certain standards for favorable tax treatment under the Health Insurance Portability and Accountability Act (HIPAA)
Definition
long-term care policies
Term
nontax-qualified policies fail to meet the
Definition
HIPAA standards
Term
facility-only policies, home health care only policies, comprehensive policies
Definition
three categories of long-term care policies
Term
typically covers care in a nursing home, assisted living facility, alzheimer's facility, or hospice as long as the insured satisfies the benefit trigger
Definition
facility-only policy
Term
covers car received outside of an institution and typically covers home health care, adult day care, and respite care
Definition
home health care policy
Term
a benefit that provides occasional full-time care to an insured who is receiving home health care services, which allows a caregiver to take a needed break
Definition
respite care
Term
typically covers care in a nursing home, assisted living facility, and hospice and also makes available optional benefits for home health care and adult day care
Definition
comprehensive policy
Term
generally provide for a care coordinator who evaluates the various options for providing care and recommends the most appropriate services for an insured
Definition
all three policies
Term
purchasers of long-term care insurance have a choice of daily benefits, which typically range from $50 to $300 or more for each
Definition
day of care
Term
the daily benefit paid for home health care may be less than the benefits paid for
Definition
nursing home care
Term
most long-term care policies are policies which reimburse the insured for actual charges up to some specified daily limit
Definition
reimbursement polices
Term
many insurers offer long-term care policies with what which provide a total dollar amount that can be used to pay for the different types long-term care services
Definition
pooled benefits
Term
a waiting period during which time benefits are not paid
Definition
elimination period
Term
can range from zero to 365 days
Definition
elimination periods
Term
a longer elimination period can substantially reduce
Definition
premiums
Term
tax qualified policies have two
Definition
benefit triggers
Term
determine whether the insured is chronically ill and eligible for benefits
Definition
benefit triggers
Term
the insured must meet only one of the two triggers to
Definition
receive benefits
Term
the first trigger requires the insured to be unable to perform a certain number of
Definition
activities of daily living (ADLs)
Term
eating, bathing, dressing, transferring from a bed to a chair, using the toilet, and maintaining continence
Definition
ADLs
Term
the second trigger is that the insured needs substantial supervision to be protected against threats to health and safety b/c of
Definition
severe cognitive impairment
Term
non-tax qualified policies often have more liberal eligibility requirements and make benefits available if a
Definition
medical necessity trigger is met
Term
means that benefits can be paid if a a physician certifies that long-term care is needed even if the insured does not meet any of the benefits triggers
Definition
medical necessity trigger
Term
can gradually erode the real purchasing power of the daily benefit
Definition
inflation
Term
protection against inflation is especially important if the policy is purchased at a
Definition
younger age
Term
one method to protect against inflation is is allowing insureds to increase the daily benefit each year based on increases in the
Definition
consumer price index (CPI)
Term
another method to protect against inflation is to automatically increase the initial daily benefit each year at
Definition
some specified rate, such as 5% compounded over the life of the policy
Term
the long-term care policies sold currently are guaranteed
Definition
renewable
Term
means once issued, the policy cannot be canceled, but rates can be increased for the underwriting class in which the insured is placed
Definition
guaranteed renewable
Term
disability-income insurance is another important form of
Definition
individual health insurance
Term
provides income payments when the insured is unable to work b/c of sickness or injury
Definition
disability-income insurance
Term
the amount of disability-income insurance you can buy is related to your
Definition
earnings
Term
to prevent overinsurance and to reduce moral hazard an malingering, most insurers limit the amount of insurance sold to no more than
Definition
60 to 80 percent of your gross earnings
Term
the complete inability of the insured to perform each and every duty of his or her own occupation
Definition
most liberal definition of total disability
Term
the complete inability to perform the duties of any occupation for which the insured is reasonably fitted by education, training, or experience
Definition
more restrictive definition of total disability
Term
the inability to perform the duties of any gainful occupation
Definition
definition of total disability commonly used for hazardous occupations where a disability is likely to occur
Term
you are considered disabled if your income is reduced as a result of sickness of accident
Definition
loss-of-income test
Term
a disability-income policy containing this definition typically pays a percentage of the maximum monthly benefit equal to the percent of earned income that is lost
Definition
loss-of-income test
Term
for some initial period of disability, such as two to five years, total disability is defined in terms of the insured's own occupation. after the initial period, of disability expires, the most restrictive definition applies.
Definition
combination of liberal and restrictive definitions of total disability that most insurers use
Term
a total disability is presumed to exist if the insured suffers the total and irrecoverable loss of sight in both eyes, to he total loss or use of both hands, both feet, or one hand and one foot
Definition
presumptive disability
Term
the inability of the insured to perform one of more important duties of his or her occupation
Definition
partial disability
Term
are paid at a reduced rate, for a short period of time
Definition
partial disability
Term
partial disability in most policies must follow a period of
Definition
total disability
Term
newer policies frequently include what type of benefit, rather than a partial disability benefit, or this provision can be added as an additional benefit
Definition
residual disability benefit
Term
means that a pro rata disability benefit is paid to an insured whose earned income is reduced because of an accident or sickness
Definition
residual disability
Term
the typical residual disability provision has a time and duties test that considers both
Definition
income and occupation
Term
means that you are engaged in your regular or another occupations, and your income is reduced b/c of an accident or sickness by at least 20% of your prior income
Definition
alternative def for residual disability that considers only the loss of earned income
Term
most insurers consider a loss of earned income in excess of 75 or 80 percent to be a loss of 100 percent, in which case the full monthly benefit for total disability is
Definition
paid
Term
one major advtg of what is the payment of a partial benefit if the insured returns to work but earnings are reduced
Definition
residual disability
Term
the length of time that disability benefits are payable after the elimination period is met
Definition
benefit period
Term
the longer the disability lasts, the less likely the disabled person will
Definition
recover
Term
if the insured is totally disabled for 90 days future premiums will be waived as long as the insured remains disabled
Definition
waiver-of-premium policy
Term
this renewal provision gives the insured the least protection with respect to continuation of coverage
Definition
optionally renewable policy
Term
the insurer has the right to terminate a policy on an anniversary date, or in some cases, on a premium date
Definition
optionally renewable policy
Term
w/ the optionally renewable policy, the policy is renewable only with the consent of the
Definition
insurer
Term
instead of non renewal, the insurer may specify the conditions that must be met before the policy is renewed
Definition
optionally renewable policy
Term
one in which the the insurer guarantees to renew the policy to some stated age, however, the insurer has the right to increase premium rates for the underwriting class in which the insured is placed
Definition
guaranteed renewable policy
Term
the policy cannot be cancelled, and renewal of the policy is at the insured's sole discretion
Definition
guaranteed renewable policy
Term
a noncancellable policy provides the greatest protection to the
Definition
insured
Term
a policy that cannot be cancelled. the insurer guarantees renewal of the policy to some stated age, and the premiums are guaranteed and connote be increased during that period
Definition
noncancellable policy
Term
allows the insured to keep the insurance in force by the timely payment of premiums until at least age 50, or if the policy is issued after age 44, for at least five years from the issue date
Definition
noncencellable medical expense policy
Term
to control adverse selection, individual medical expense policies usually contain some type of
Definition
preexisting-conditions clause
Term
a physical or mental condition for which the insured received treatment or that existed during some specified time period prior to the effective date of the policy
Definition
preexisting-conditions clause
Term
are not covered until the policy has been in force for a specified period, unless the condition is disclosed in the application and is not excluded by a rider
Definition
preexisting conditions
Term
usually applies to health conditions not disclosed in the application
Definition
the preexisting-conditions exclusion
Term
under this provision you are required to give written notice to the insurer w/in 20 days after a covered loss occurs or as soon as is reasonably possible
Definition
notice of claim provision
Term
under this provision, the insurer is required to send you a claim form w/in 15 days after notice is received
Definition
claim forms provision
Term
under this provision, you must send written proof of loss to the insurer w/in 90 days after a covered loss occurs
Definition
proof-of-loss provision
Term
the time limit on certain defenses is a required provision and has the same effect as the
Definition
incontestable clause in life insurance
Term
states that after the policy has been in force for two years, the insurer cannot void the policy or deny a claim on the basis of misstatement in the application, except for fraudulent misstatements
Definition
time limit on certain defenses
Term
insure for the catastrophic loss, consider group health insurance first, purchase a policy that has a preferred provider network, don't ignore disability-income insurance, avoid limited policy, use deductibles and elimination periods to reduce premiums
Definition
guidelines for shopping for individual health insurance
Term
covers only certain diseases or accidents, pay limited benefits, or places serious restrictions on the right to receive benefits
Definition
limited policy
Term
one example of a limited policy, pays a fixed daily or monthly cash benefit if you are admitted to a hospital
Definition
hospital confinement indemnity policy
Term
another example of a limited policy - covers only certain diseases listed in the policy, such as cancer, multiple sclerosis, or muscular dystrophy
Definition
specified (dread) disease policy
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