Terms
what is a premium?
The amount that a person or business must pay for a certain insurance policy
What is a PPO?
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers.
What is Major Medical Insurance?
Health insurance that covers the expenses associated with serious illness or hospitalization.
what is the affordable care act?
A piece of legislation that is supposed to make health insurance cheaper and more accessible to the average citizen
How do you calculate co-insurance?
Find the coinsurance rate depending on the medical service. Find the cost of care. Next, multiply your coinsurance rate X total cost of care = coinsurance you owe
What are the advantages of an HMO?
less expensive
smaller network
local network
What is Disability Income?
a plan that provides periodic payment of benefits when a disabled insured person is unable to work.
What are some of the benefits that all health plans are required to have?
Ambulatory patient services (outpatient services)
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
How much of your Income does disability income insurance cover?
45-65% of your tax-free gross income
what is a POS?
combines the benefits of HMOs and PPOs.
primary care doctor required
what are the pros of Major medical insurance?
Emergency coverage
No lifetime limits
Affordable premiums
What are the pros of the affordable care act?
More Americans have access to health insurance
People with pre-existing conditions can no longer be denied coverage
No more time limits on care
Children can stay under their parents’ health insurance plans until the age of 26
What is a deductible?
The amount you pay for health care before your insurance plan starts to pay.
What is a con of having a PPO
Expensive out of network services
What are the cons of major medical insurance
High Deductibles
Limited coverage
Significant out of pocket costs
What are the cons of the affordable care act?
Income taxes are raised for everyone
The signing up process is pretty complicated
Everyone must have insurance even if they don’t want it. Not having insurance can lead to modest fines
Wait times are longer
What is an insurance claim?
a bill from health care services that your doctor’s office turns in to the insurance company for payment. The insurance company then decides which of the services they will pay for
When is it best to have a PPO?
best if you want more provider options but no required referrals
Why do people need disability income insurance?
because some people get so hurt that they are not physically able to work. This should not put them at a disadvantage financially.
In what year was the Affordable Care Act put into place?
2010