History of Health Insurance
What is health insurance?
a contract between a policyholder and a third-party payer or government program
What was the Affordable Care Act created to do?
The ACA lowers costs, guarantees choice, and enhances health care
The ACA was in effect from 2010-2020
The goal was for everyone to have healthcare
What is major medical?
designed to offset larger medical expenses caused by prolonged illness or serious injury
What is a deductible?
a specific amount of money that must be paid each year before the policy benefits begins
What is a medical savings account?
tax-free savings account that allows individuals and their employers to set aside money to pay for health care expenses
Blue cross/blue shield
What was a downfall of the ACA?
Americans were required to have insurance or face a penalty each year
If insurance wasn't held, the person had to pay a fine
The insured is known as the
subscriber, member, policyholder, or recipient
What is cost sharing?
the insured will assume a percentage of the fee called coinsurance or pay a specific dollar amount called a copay
What is a health savings account?
tool for defraying medical costs. Anyone under the age of 65 who enrolls in a high deductible plan
What is a premium?
amount you pay for the insurance plan
What is Exchanges?
Exchanges is an organized marketplace where uninsured individuals and small-business owners can find all the qualified private health plans available in their area.
Exchanges were created to lower health care cost
Children can stay on their parents insurance policy until they turn
26
What is the birthday rule?
the health plan of the parent whose birthday comes first in the calendar yar is designated as the primary plan
What is a health reimbursement account?
usually offered with high deductible plans. The employer owns the account and only they can make contributions. They can decide the contribution and define covered expenses. If the employee leaves, the money stays with the employer
Name the insurance plans that are government funded.
Medicare, Medicaid, Tricare
What is a contract?
legal and binding written document that exists between two or more parties
What must be paid before a policy will go into effect?
premium
What is mandated benefits?
state and/or federal laws that require coverage for treatment of specific health conditions for some categories of dependents, such as children placed for adoption
What is a Health Maintenance Organization?
Provides a wide range of comprehensive health care services
Fixed periodic payment
Emphasis is on preventative care
What did original insurance cover?
Original insurance only paid for lost wages when an individual was sick or received an injury
What is a guarantor?
person who accepts treatment or signs a form agreeing to pay
What is a noncancelable policy?
the insurer cannot increase premium rates and must renew the policy until the insured reaches the age specified in the contract.
What is a preexisting condition?
conditions that existed and were treated before the policy was issued
What is a preferred provider organization?
Form of contract medicine by which a large employer, or any organization that can produce a large number of patients, contracts with a hospital or a group of health care organizations to offer medical care at a reduced rate.