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25 Cards in this Set

  • Front
  • Back
tend to see health care events as unplanned and somewhat random events causing losses for which reimbursement can be provided
traditional health insurers
tend to see health care events as expected losses which can be paid for in advance based on some average expected level of expenditures
Managed care plans
have traditionally been modeled after insurance but are increasingly managed care
government plans (medicare and medicaid)
covers the hospital stay
hospital (hospitalization) insurance
covers the surgical procedure
surgical insurance
covers office visits, prescriptions, devices, consultations, etc. up to limits
medical expense insurance
major medical expense insurance
covers hospital, surgical and medical expenses
based on traditional insurance but i fyou use the preferred provider you get a break on deductibles and or coinsurance
preferred provider organizations
are not insurance, but health care providers or managers of health care delivery
groups of health care providers who band together to provide health insurance, usually in rural areas
provider sponsored networks
medical care plans for the elderly administered by the social security administration
is a joint federal/state program for the poor, does not cover nursing home care
provides reimbursement for costs associated with intermediate and custodial care in a nursing facility or at home
long-term care insurance
the covered person or family pays an initial dollar amount, usually on a per year basis
the covered person or family to pay an initial portion of a particular expenses item such as an office visit or prescription
requires the covered person or famimly to pay a set percentage of the losses after paying the deductible
put dollar max. payments on particular health care procedures or expenses such as an x-ray or an office visit
item limits
set a dollar limiti on a particular health care episode
episode limits
use group underwriting and thus are cheaper and easier to use for those who havce health care predispositions
group plans
windows of time when one can join or change plans or select differeing features of your plan
open-enrollment periods
may be excluded for a time or permanently
pre-existing conditions
allows you to stay a membe rof the group when leaving a job; you pay the premium
allows conversion of a group plan into an individual plan
windows of time after premium due date during which the premium can be paid with unbroken coverage from the due date
grace period
provides a partial replacement of income when disabeled
disability income insurance