HMO/PPO
This individual is often referred to as a "Gatekeeper".
What is a Primary Care Physician?
These policies are generally not tax deductible for the premium, unless the annual premiums exceed 7.5% of their AGI.
What is individual policies?
This is a platform where individuals can compare, shop, and enroll in ACA-compliant health plans.
What is the Health Insurance Marketplace?
Under NAIC Model Law:
•Weekly Premiums: 7-days.
•Monthly Premiums: 10-days.
•All other policies: Not less than 31 Days.
Under Subsidized Policies:
•90-day period:
•1st Month: Insurer must pay all valid claims.
•Months 2-3: Insurer may “pend” claims until outstanding premium is paid before end of 90 days.
What is a Grace Period?
This is the legal term for an insurance company representative who typically includes both agents and brokers.
What is a Producer?
This plan type allows you to see out-of-network providers, but it is not financially advisable to do so.
What is a PPO?
This policy, which would cover the rent of the building your business is in, is deductible with the premiums for the employer.
What is the Business Overhead Expense Policy?
The law allows states to expand Medicaid to adults with incomes below 138% of the FPL (Federal Poverty Level).
What is the Medicaid Expansion?
In a Long-Term Care Policy, this would typically be 90 days.
In Short-Term Disability Policies, this would generally be 0-14 days. However, in Long-Term Disability Policies, this would extend out to 180 days.
What is the Elimination Periods?
This is a statement that, if discovered, would alter the underwriting decision of the insurance company.
What is Material Misrepresentation?
This is the process you must take to see a Specialist on an HMO plan, but is typically not required on a PPO.
What is a Referral?
These are the two types of payments typically seen on an insurance plan, with one being a percentage and the other being a flat cost per service.
What is coinsurance & copayment?
This plan type is often used to fill in the gaps Original Medicare leaves behind and does not typically include prescription drug coverage.
What is a Medicare Supplement Plan?
This is the time period where someone who was terminated from a company is allowed to receive COBRA for themselves.
What is 18 months?
This insurance contract characteristic means that unequal amounts may be exchanged between the insured and the insurer.
What is Aleatory Contract?
These are the terms that make up the acronyms HMO & PPO
What is Health Maintenance Organization & Preferred Provider Organization?
These policies are not taxable on withdrawls when used for Medical Expenses; Taxable as regular income when used for non-medical use, plus 20% penalty under 65: no penalty for over 65.
What are HSA policies?
These are the 4 plan letters of Original Medicare and what they mean.
What is
Part A: Hospital
Part B: Outpatient Medical
Part C: Medicare Advantage
Part D: Medicare Prescription Drug Coverage
This is the length of time allowed for the insured to notify the insurer of a claim after a loss.
What is 20 days?
These are the four essential elements required for an insurance contract to be legally binding.
What is Agreement (Offer and Acceptance), Consideration, Competent parties, and Legal Purpose?
These plans allow members to choose between in-network or out-of-network care every time they need medical services, blending HMO and PPO features.
What is a Point of Service (POS) Plan?
This is the cost someone would have to pay out of pocket for the following:
Hospital bill: $5000
Deductible: $500
Coinsurance: 20%
What is $1,400 out of pocket.
These are the 10 Essential Health Benefits Required by the ACA.
What is: Ambulatory Patient Services, Emergency Services, Hospitalization, Maternity and Newborn Care, Mental Health/ Substance Use Disorder Services, Prescription Drug, Rehabilitative Services/ Devices, Laboratory Services, Preventative Wellness Services/ Chronic Disease Management, Pediatric Services?
This is the minimum length of time that policyholders must wait after submitting written proof of loss before they are allowed to take legal action.
What is 60 days?
Someone who conditions the renewal of an insurance policy on the condition that the beneficiary purchase an additional insurance policy from the agent may be guilty of this.
What is coercion?