Shared Flashcard Set

Details

Texas Life and Health
Health Types of Policies
51
Finance
Professional
08/06/2004

Additional Finance Flashcards

 


 

Cards

Term
Medical Expense
Definition
_________________ policies provide benefits for the cost of medical care that results from accidents and sickness.
Term
hospital;surgical;medical;first dollar;no deductable;low dollar
Definition
Base plans cover three basics _______________, ______________, and ______________. They feature ____________, ______________,and _______________ coverage limits.
Term
room & board; miscellaneous
Definition
Basic Hospital policies cover hospital ________________
Term
Basic Medical Expense
Definition
__________________ policies are designed to pay for the non-surgical doctors services.
Term
Basic Surgical Expense;surgical schedule;relative value
Definition
_____________________
Term
medical;supplement major medical; comprehensive major medical
Definition
Policies that provide a broad range of catastrophic medical expense protection under one plan are known as major _________________________ expense policies. The two types available are: _____________________, and _________________.
Term
deductable;coinsurance; large benefit maximums
Definition
In order to prevent over-utilization of the policy, Major Medical plans make use of ___________________
Term
base plan;corridor;coinsurance
Definition
In a Supplementary Major Medical policy the ____________________ pays first, followed by a ____________________ deductible, then the ____________________ feature.
Term
first dollar; % of incurred cost
Definition
A Comprehensive Major Medical policy without a deductible will pay ___________________ coverage for basic medical benefits after which the insured will pay a __________________.
Term
service providers;prepaid;subscribers
Definition
Health Maintenance Organizations (HMO's) are known as _________________________ as they provide medical services on a ~ 10 basis. Insured's are called _______________________
Term
capitation;group model
Definition
An HMO that contracts with an independent medical group to provide services and pays the group on a _______________ fee basis is called a _____________________.
Term
staff model;salaried employees
Definition
In a
Term
independent practice association
Definition
With an __________________ the HMO contracts with a combination of independent physicians, medical groups and associations, and the doctors are paid on a fee-for-service basis.
Term
preventative care;primary care physician;gatekeeper
Definition
HMOs' stress __________________________. At enrollment, the insured selects a ______________________ (also referred to as a __________________________ to oversee and coordinate referrals.
Term
closed panel;open panel
Definition
In a ________________ the HMO has an exclusive arrangement with the doctors or hospitals to provide services only to its members. In an ____________________ the doctors and hospitals reserve the right to treat patients not with the HMO.
Term
no choice of doctor; full coverage
Definition
A major drawback to HMOs is that the insured has ______________________ and must see a plan doctor or utilize their facilities to have ______________________________.
Term
PPOs
Definition
______________________ encourage the insured to utilize approved member doctors and hospitals.
Term
fee for service;full coverage;reduced
Definition
PPOs differ from HMOs in two ways. First, they provide services on a negotiated __________________________ basis. Second, the insured must utilize a plan doctor or facility to have ____________________ or their benefits will be _______________________.
Term
managed care;HMOs;PPOs
Definition
________________________ refers to any program designed to contain costs by controlling the behavior of the participants in the plan. ___________ and ___________ are excellent examples of this type of plan.
Term
MET
Definition
A ___________________________ is comprised of a number of individual or small groups of individuals who do not qualify for group insurance so they band together to purchase insurance.
Term
MEWA
Definition
A _____________________________ is a group of employers who pool their risk in order to self-insure.
Term
Blue Cross;Blue Shield;Service Plans;Hospital / Physician;Subscribers
Definition
____________________ and ___________________ are similar to HMOs in several ways. They are considered _________________, because benefits are paid to the ____________________ not the ___________________.
Term
Hospital;Doctors
Definition
Blue Cross provides benefits for __________________ expenses; Blue Shield provides benefits for _________________ expenses.
Term
Disability Income Policies
Definition
________________________ are intended to replace your income if you become totally disabled and unable to perform work duties for a period of time.
Term
any occupation
Definition
The ________________________ definition for total disability requires you to be unable to perform any occupation for which you are reasonably suited by reason of education, training or experience.
Term
own occupation
Definition
The __________________________ is the more liberal definition of total disability.
Term
presumptive disability;any 2 limbs;speech;sight in both eyes
Definition
_____________________________ specifies the conditions that will automatically qualify you for full disability benefits. They are the loss of __________________, __________________, or ____________________, and __________________________________________ (total and permanent).
Term
recurrent;elimination
Definition
When an insured goes back to work after total disability and suffers a relapse within a specified time period, the ______________________ provision states that it will not be counted as a new period of disability and there will be no new _______________________period.
Term
elimination period
Definition
The period of time you go without benefits at the onset of a disability is your ________________________
Term
probationary period;illness
Definition
The period of time you are not eligible for benefits after the issuance of a disability policy is the __________________________________ This usually only applies to ____________________-related disabilities.
Term
accidental bodily injury;accidental means
Definition
Injury in Disability Income policies would be defined using either the _____________________________ or the ________________________ definition.
Term
sickness
Definition
__________________in a Disability Income Policy would be defined as either an illness or disease contracted after the policy has been in force for at least 30 days.
Term
malingering
Definition
Insurance companies will not reimburse 100% of lost income to prevent __________________________
Term
social insurance supplement (SIS)
Definition
______________________ riders supplement or replace benefits that might be payable under Social Security Disability. Generally, they pay what Social Security will not.
Term
Business Overhead Expense (BOE);salary
Definition
A _____________________ policy is designed to cover various business expenses associated with operating a business when the owner is on disability. These policies will not cover the business owner's ____________________.
Term
key person
Definition
A ____________________ disability income policy provides a benefit to the employer if a covered employee becomes disabled.
Term
disability buyoff agreement;elimination period;totally;permanently
Definition
A ________________________________________________ specifies who will purchase a disabled partner's interest in the company if totally disabled. These policies generally have a one or two-year ___________________________ to make sure the partner is _________________________ and __________________ disabled.
Term
flat dollar;percentage
Definition
Individual Disability policies usually specify a ________________________ benefit payable; group policies usually pay a __________________ of the worker's income.
Term
6 months;2 years;13 weeks;26 weeks;50%;100%
Definition
Individual short-term disability periods usually have maximum benefit periods of _________ to _________; group plans are generally ________________ to ______________ with benefits of __________________ to ________________ of the worker's income.
Term
2 years;60%
Definition
Group long-term plans provide maximum benefit periods of more than _______________ with monthly benefits usually limited to _________ of income.
Term
30;90
Definition
Group plans usually require that the employee must have worked ____________ to ________________ days before they become eligible for benefits.
Term
limited risk policy;special risk policy
Definition
Two special AD&D policies that pay benefits under specific circumstances are the ___________________ and ______________________________.
Term
LTC - long term care;12 consecutive
Definition
_________________________________ insurance must provide coverage for at least _______________ months in a setting other than the acute care unit of a hospital.
Term
ADL - activities of daily living
Definition
Perils for LTC policies are _________________________.
Term
skill nursing care;intermediate care;home health care
Definition
LTC policies will cover three levels of care: ___________________, ____________________, and _____________________.
Term
30 or more days;2 years to 5 years;50 to 200 dollars
Definition
LTC policies have an elimination period and benefit period that is usually _______________________________, and benefit periods are usually ________________________ with a benefit amount payable of _________________ per day.
Term
30 days;guaranteed renewable
Definition
LTC policies have a free look period of __________________, and the minimum level of renewability must be ____________________.
Term
association;100;2 years;constitution;bylaws;annually
Definition
_____________________ groups must have ________ members, be organized for a reason other that buying insurance, been active for ______________________, have a _____________________ and __________________, and hold meetings ______________________ in order to purchase insurance for their members.
Term
without evidence;31 days
Definition
Terminated employees may convert their group policy to an individual policy ____________________ of insurability. They have _________________ from date of termination to exercise this option.
Term
cobra;20;termination;misconduct;divorce;separation
Definition
________________ requires any employer with _______or more employees to extend group health coverage to
Term
18 months;36 months;29 months;60 days
Definition
Coverage under COBRA is extended for _________________ due to termination of employment______________for death and divorce or separation, and _____________________________ if on Social Security Disability. Terminated employees have ____________________ to exercise this option.
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