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30 Cards in this Set
- Front
- Back
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What types of injuries and services will be excluded from major medical coverage? |
Injuries caused by war, intentionally self-inflicted injuries, injuries covered by workers compensation, regular dental/vision/hearing care custodial, care, and elective cosmetic surgery |
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What is the main principle of an HMO plan? |
Preventative care |
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What is the capital sum in accidental death and dismemberment (AD&D) coverage? |
A percentage of the principal sum |
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What types of groups are eligible for group health insurance? |
Employer-sponsored and association-sponsored groups |
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What is the purpose of respite care in long term care insurance? |
To provide relief for a major caregiver (usually a family member) |
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What type of hospital policy pays a fixed amount each day that the insured is in the hospital? |
Hospital indemnity |
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Can an insured who belongs to a POS plan use an out-of-network physician? |
Yes, but the co-pays and deductibles may be higher |
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What is the term for a period of time immediately following a disability during which benefits are not payable? |
Elimination period |
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What are the three types of basic medical expense insurance? |
Hospital, surgical, and medical insurance |
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How can an HMO member see a specialist? |
Referral by the primary care physician |
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Why do HMOs encourage members to get regular checkups? |
To help catch health problems early when treatment has the greatest chance for success (I.e. Preventive care) |
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Who are the parties in a group health contract? |
The employer and the insurer |
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What is the primary purpose of disability income insurance? |
To replace income lost due to a disability |
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Can Alzheimer’s disease be excluded from coverage under a long-term care policy? |
No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered |
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In what type of health plans are providers paid for services in advance, regardless of the services provided? |
Prepaid plans |
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With key person disability insurance, who pays the policy premiums? |
The business (employer) |
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In health insurance, what is considered a sickness? |
An illness that first arises while the policy is in force |
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What are the two types of flexible spending accounts? |
Healthcare accounts and dependent care accounts |
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What is the role of the gatekeeper in an HMO plan? |
To control costs for the services of specialist |
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How are HMO territories typically divided? |
Geographic areas |
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What is a fee-for-service health plan? |
Under a fee-for-service plan, providers receive payments for each service provided |
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What do individual insured receive as proof of their group health coverage? |
Certificate of insurance |
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What is the purpose of a buy-sell agreement for health insurance policies? |
To specify how the business will pass between owners when one of them dies or becomes disabled |
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What type of health insurance would pay for hiring a replacement for an important employee who becomes disabled? |
Key-person disability insurance |
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What is the purpose of COBRA? |
To allow continuation of health insurance coverage for terminated employees |
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Who chooses a primary care physician In an HMO plan? |
The individual member |
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Under what type of care do insurers negotiate contracts with healthcare providers to allow subscribers access to healthcare services at favorable cost? |
Preferred provider organization (PPO) |
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In order to be eligible for coverage by an HSA, an individual must also be covered by what type of health plan? |
High deductible health plan (HDHP) |
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In group insurance, what is the name of the policy? |
Master policy |
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What does the amount of disability benefit that an insured can receive depend on? |
The insured’s income at time of policy application |
