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FIL 250 - health ins
Health insurance
| Question | Answer |
|---|---|
| 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
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