Definitions
What is a premium?
The amount paid, usually monthly, to maintain health insurance coverage.
What does HMO stand for?
Health Maintenance Organization
Give 1 characteristic of a No-Deductible Plan
Yes or No: Is HRA portable? do you keep the benefit after leaving the company?
No
What is a co-pay?
A fixed amount you pay for a covered healthcare service or prescription.
1. More flexible network: Use in-network for lower costs. Out-of-network is allowed (though at a higher cost)
2. No Referrals Needed (unless it is out-of-network)
3. More doctors and specialists compared to HMOs.
Yes or No: Does a Low-Deductible Health Plan have an out-of-pocket maximum?
No. There is no out-of-pocket maximum for LDHPs.
Name a common type of FSA.
1. Healthcare FSA
2. Dependent Care FSA
What is an out-of-network provider?
Healthcare providers that are not part of the plan's network, often resulting in higher out-of-pocket costs.
What is 1 disadvantage of an EPO (Exclusive Provider Organization)?
1. Limited Network (The most restrictive option)
2. Very limited choice of doctors and specialists.
3. No out-of-network coverage (except in an emergency)
What is a drawback when choosing a High-Deductible Health Plan (HDHP)?
Higher potential out-of-pocket costs upfront before the insurance kicks in. May not be suitable for individuals with frequent medical needs.
What does HSA stand for?
Health Savings Account
What is a deductible?
The amount you must pay out-of-pocket before your insurance starts covering costs.
What is a disadvantage of PPO (Preferred Provider Organization)?
1. Usually has higher premiums
2. Out-of-network care can be very expensive
What is a drawback when choosing a Low-Deductible Health Plan (HDHP)?
Typically has a higher monthly premiums compared to HDHPs. May not be as cost-effective if you don't anticipate needing frequent medical care.
What is 1 advantage of an HSA?
What is a referral?
A written order from your primary care physician for you to see a specialist or get certain medical services.
What does POS stand for?
Point-of-Service
What is a benefit of High-Deductible Health Plans (HDHP)?
1. Often has lower monthly premiums.
2. May be paired with a Health Savings Account (HSA) to contribute pre-tax dollars for qualified medical expenses (including the deductible).
Yes or No: Are self-employed individuals eligible for a Flexible Spending Account (FSA)?
No, they are not eligible.