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FIL 250 - health ins

Health insurance

Four major problems in US health care system 1. rising costs 2. uninsured population 3. uneven quality 4. waste and inefficiency
Indemnity health insurance patients have no restriction on doctors, doctors are paid for each service, no cost containment features
basic medical plan (hospital-surgical insurance) creates a list of inpatient services provided along with the scheduled benefit for each service
major medical insurance pays a large proportion of medical expenses for catastrophic illness or injury. Includes a deductible, coinsurance, and out of pocket maximum
managed care health care coverage that has a goal of holding down escalating costs, often by restricting doctor choice
preferred provider organization (PPO) patients can choose to go to a restricted list of doctors (called the network) where services are provided at lower costs to members or they can select their own doctor at an increased cost
health maintenance organization (HMO) health system that organizes medical resources and provides comprehensive services for its members in exchange for a fixed fee. Members pay copayments for each service without filing claims forms
point of service plans (POS) similar to an HMO, but with out of network benefits for those selecting their own doctor (with increased cost sharing)
health savings account (HSA) a tax-advantaged investment account where money can used to pay for medical expenses. must be coordinated with a high deductible health plan
COBRA provision that allows people to temporarily keep their employer's health insurance upon termination
What are key elements of ACA to reduce number of uninsured? expand Medicaid, provide subsidies to pay for coverage, extend coverage for children to age 26, health exchanges, eliminate pre-existing conditions, individual and employer mandate
pre-existing conditions limitation (PCL) (old) provision that would allow health insurers to carve out coverage for medical conditions that existed prior to issuing insurance
long-term care insurance pays for medical or custodial care at nursing home, hospital, or home
Created by: isufil250
Popular Insurance sets




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