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HI Plan
Test on Tuesday
| Question | Answer |
|---|---|
| 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 |
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