medical expense insurance
pays only the medical costs
disability income insurance
provides payments to make up for some of the income of a person who cannot work as a result of injury or illness
Three ways insurance may be purchased
group health insurance, individual health insurance, COBRA
Group plans
employer sponsored.
Employer offers the plan and pays some or all of the premiums. Also offered through unions or professional associations
policy
contract with risk sharing group
COB
Coordination of benefits
Individual health insurance
bought by those who self-employ, or who don't get insurance through their job. sometimes bought to supplement work insurance.
COBRA
Consolidated Omnibus Budget Reconciliation Act; law to provide terminated employees or those who lose insurance coverage because of reduced work to be able to buy group insurance for themselves and their families for a limited amount of time.
Basic health insurance coverage
hospital expense insurance, surgical expense insurance, and physician expense insurance
hospital expense coverage
pays part or all of hospital bills for room, board and other charges
surgical expense insurance
pays part or all of the surgeon's fees for an operation
Physician expense
provides benefits for doctor's fees for nonsurgical care, x-rays, and lab tests
coinsurance
provision under which both the insured and the insurer share the covered losses
stop-loss
provision under which an insured pays a certain amount, after which the insurance company pays 100 percent of the remaining covered expenses,like how our insurance made us pay a certain amt and then they covered everything the rest of the year
hospital indemnity policies
pays benefits when you're hospitalized, in cash. Doesn't directly cover medical costs, you spend cash on medical or non-medical expenses
dental expense insurance
self explanatory.
vision care insurance
eye examinations, glasses, contact lenses, eye surgery, treatment of eye diseases
dread disease policies
dread disease, trip accident, death insurance, cancer policies
usually sold door to door
plays on people's unrealistic fears
illegal in most states
usually covered in major medical plans already
Long term care insurance (LTC)
provides day in, day out care for long term illness or disability
reimbursement vs indemnity
a reimbursement policy pays you back for actual expenses. indemnity provides you with specific amts, regardless of how much the actual expenses may be
internal limits vs aggregate limits
policy with internal limits will cover only a fixed amt for an expense, such as the daily cost of room and board during a hospital stay.
aggregate limits will limit only the total amt of coverage, i.e. $1 million in major expense benefits
deductibles and coinsurance
deductible is a set fee depending on type of service, and insurance covers the rest.
coinsurance is based on a percentage
out-of-pocket limits
limit the amt of money you must pay for the deductible and coinsurance. lower financial risk but increase out of pocket expenses
Who provides most health insurance in the U.S.?
private organizations rather than the govt
blue cross
A primarly non-profit corporation that offers prepaid medical benefits for hospital services, and some outpatient, home care, and other institutional services
blue shield
provides benefits for surgical and medical services performed by physicians.
managed care
prepaid health plans that provide comprehensive health care to members, offered by HMO's, PPO's, POS's
HMO
A health insurance plan that provides a wide range of health care services for a fixed, prepaid monthly fee.
Based on the idea that preventive services will minimize future medical expenses
Health Maintenance Organizations
PPO
Preferred provider organization
a group of doctors and hospitals that agree to provide health care at rates approved by the insurer
POS
Point of Service plan
network of selected contracted, participating providers, also called an HMO-PPO hybrid or open-ended HMO
HSA
Health savings account---you contribute pre-tax dollars to the account for expected medical expenses for the coming year-often set up through your employer-submit claims and receipts for reimbursement up to amount deposited.
HRA's
Funded solely by employer, give you a pot of money to spend on health care. You can carry over unspent money from year to year. premiums are lower than traditional insurance but higher than HSA's. You can invest the funds in stocks, bonds, and mutual fund
FSA's
allow you to contribute pretax dollars to an account managed by your employer. You use the money for health insurance but forfeit anything left over
medicare
government health program available mainly to people over 655 and to people with disabilities. Consists of four parts, pg 302
medigap
supplements medicare by filing the gap between medicare payments and medical costs not covered by medicare. offered by private companies
medicaid
medical assistance program offered to low income families, more comprehensive than medicare
disability income insurance
provides payments to replace income when an insured person is unable to work