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14 Cards in this Set
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- Back
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-Refers to the broad field of insurance plans that provide protection against the financial consequences of illness, accidents, injury, and disability. |
Health Insurance |
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-Provides financial protection against the cost of medical care by reimbursing the insured, fully or in part, for these costs. It includes many kinds of plans that cover hospital care, surgical expenses, position expenses, medical treatment programs, outpatient care, and the like. |
Medical Expense Insurance |
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-Designed to provide a replacement income when wages are lost due to disability. It does not cover the medical expenses associated with a disability, rather it provides the disabled insured with a guaranteed flow of periodic income while they are disabled. |
Disability Income Insurance |
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-The purest form of accident insurance providing the insured with a lump sum benefit amount in the event of accidental death or dismemberment under accidental circumstances. |
Accidental Death And Dismemberment Insurance (AD&D) |
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-Set aside by an insurance company and designated for the payment of future claims. Part of each premium is designated for this. |
Reserves |
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-A type of health plan allowing the covered person to choose to receive a service from a participating or non-participating provider, with different benefit levels associated with the use of in-plan and out-of-plan providers. |
Point-of-Service Plan (POS) |
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-The type of organization offering comprehensive prepaid healthcare services to its subscribing members. -Distinguished by the fact that they not only finance a health care services for their subscribers on a prepayment basis, but they also organize and deliver the health services as well. Subscribers pay a fixed periodic fee and are provided with a broad range of health services, from routine doctor visits to emergency and hospital care. |
Health Maintenance Organization (HMO) |
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-A collection of healthcare providers, such as physicians, hospitals, and clinics, who offer their services to certain groups at pre-arranged prices. In exchange, the group refers its members to the preferred providers for healthcare services. -Unlike HMOs, this organization usually operate on a fee for service rendered basis, not on a prepaid basis. |
Preferred Provider Organizations (PPO) |
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-This federally administered program took effect in 1966. Its purpose is to provide hospital and medical expense insurance to those aged 65 or older, to those of any age who suffer from chronic kidney disease, or to those who are receiving Social Security disability benefits. |
Medicare
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-Title XIX of the Social Security Act, added to the Social Security program in 1965. Its purpose is to provide matching federal funds to states for their medical public assistance plans to help needy persons, regardless of age. |
Medicaid |
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-In addition to Medicare, the federal government also provides disability related benefits through the Social Security OASDI program. -Disability income benefits are available to covered workers who qualify under social security requirements. One of the requirements is that the individual must be so mentally or physically disabled that he cannot perform any substantial gainful work. In addition, the impairment must be expected to last at least 12 months or result in earlier death. - A five month waiting period is required before an individual will qualify for benefits, during which time they must remain disabled. |
Social Security Disability Income |
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-A method of marketing group benefits to employers who have a small number of employees. -Can provide a single type of insurance (health insurance) or a wide range of coverages (life, medical expense, and disability income insurance). -An employer who wants to get coverage from this must first become a member of the trust by subscribing to it. -May either provide benefits on a self-funded basis or fund benefits with a contract purchased from an insurance company. |
Multiple Employer Trusts (MET) |
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-Type of MET. It consists of small employers who have joined to provide health benefits for their employees, often on a self insured basis.
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Multiple Employer Welfare Arrangements (MEWA)
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