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HI Plan

Test on Tuesday

a plan that helps the consumer pay for medical cost Health Insurance Plan
an illness already present when applying for a new insurance plan pre-existing condition
law that states all individual in a given population must be insured guraranteed issue
Medicare pays a set amount for specific classifications of diagnoses regardless of actual cost DRG's (Diagnostic Related Groups)
Laws limiting medical malpractice suit payments Tort Reform
employee can pay to keep group health insurance for 18-36 months after leaving a job or losing health insurance and prevents "lapse in coverage" situation which prevents issues with per-existing conditions COBRA (consolidated Omnibus Budget Reconciliation Act) ~1986~
amount you pay to belong to a health plan premium
amount you must pay each year before health plan begins paying deductible
% of medical costs a person must pay after meeting deductible Co-insurance
set fee paid each time person receives medical care Co-pay
employer offers plan to workers, share cost of premiums Group insurance
purchase plan directly from insurance company, pay own premiums individual insurance
can choose provider, deductible and co-insurance must file an insurance claim for each service Indemnity insurance
a "network" of providers on the plan, cost lower if use network providers, no insurance claim forms, co-pays Managed care plan
receive most of care from primary care doctor, specialists require a referral, will only pay for network providers, pays for routine and preventative care HMO (Health maintenance Organizations)
No referrals for specialists, can use network or non-network providers, pay more for non-network PPO (Preferred Provider Organization)
federal, health coverage for age 65 and older and certain disabilities Plan A:hospital coverage/no premium, Plan B: Physician coverage/premium/optional Medicare
Federal, administered by states, covers those with low income and disabled, eligibility and benefits vary by state Medicaid
State medical coverage for low income children who do not qualify for medicaid SCHIP/CHIP (State Children's Health Insurance Program)
Covers medical care for on the job injuries, covers part of wages lost due to injury, cost shared by state and employer Worker's Compensation
Federal medical plan for active duty and retired military personnel, their dependents, and survivors CHAMPUS (Civilian Health and Medical Program US)
federal law requires that hospital emergency departments treat emergency condition of all patients regardless of their ability to pay EMTALA
state-based brokerages (agencies) where uninsured us citizens, legal immigrants, and small businesses can purchase insurance health insurance exchanges
a minimum income level below which a person is officially considered to lack adequate subsistence and to be living in poverty federal poverty income (FPI)
monetary assistance granted by the government to an individual or group in support of a project regarded as being for the public good subsidy
money made on investments, alimony, child support, etc. -you did not have to earn or work for it unearned income
expensive employer paid health plans valued at 10,200 per employee or 27,500 for their family Cadillac plans
pre-tax savings accounts from which you can pay for health care expenses flexible spending accounts (fsa)
can carry over unused money year to year HSA
estimate carefully use it or lose it end of year HRA
an attempt to find a solution to the high cost of health care and to improve access to care for those who can least afford it patient protection and affordable care act
an attempt to create balance to make health care equally accessible and equally affordable to all citizens Reconciliation
by 130 billion over 10 years further reduce the deficit by 1.2 trillion in the second 10 years reduce federal deficit
affordability individual responsibility employer responsibility defining income subsidies and implementation of funding primary focus will be on
Created by: ChangingPhases