Flashcards
H3: Medical Expense Insurance (Section I)
Cards in this deck (19)
- 1Indemnity Type PlansBasic Medical Expense, Major Medical Expense
- 2Indemnity type PlansInsured chooses his own doctors, hospitals and other heath care providers
- 3Indemnity Plans, claim forms are typically completed and submitted by the participant (insured)Indemnity Plans, claim forms are typically completed and submitted by the participant (insured)
- 43 Basic Medical Expense PoliciesHospital Expense, Surgical Expense, Physicians Visit Expense
- 5Hospital ExpenseHospital Room and Board, Lab/Xrays Charges, Operating Room
- 6Surgical Expenseprimary surgeon Fee, 2nd opinion, asst surgeon/anesthesiologists
- 7Physicians Visit ExpenseDoctor hospital visits, doctor office visits
- 8Possible Benefit Structures for Surgical Expense PoliciesSchedule of Fees, UCR (Usual, customary, reasonable) insurer pays fees most consistent with those in a particular geographic region, Relative Value Units
- 9First $ CoverageNo deductibles, copays, coinsurance
- 10Methods of ReimbursementsReimbursements, Indemnity, Service
- 11Reimbursementinsurer pays the actual cost or % of actual cost for covered procedures and services, regardless of how much they cost.
- 12Indemnityinsurer pays a specified amount per day for a specified maximum number of days
- 13Servicepolicy benefits are expressed in terms of the services provided rather than dollar maximums
- 142 Major Medical Expense PoliciesComprehensive and Supplemental
- 15Comprehensivea single major medical contract that covers most medical expenses
- 16restoration of benefitsprovision that allows policy's Life time Max to be restored. It might require insured to periodically prove insurability or might automatically reset each year.
- 17Supplementala type of major medical policy that is purchased in conjuction with one or more Basic Medical Expense polices to provide broader coverage.
- 18Basic + Supplemental= ComprehensiveBasic + Supplemental= Comprehensive
- 19Corridor Deductiblesa deductible paid AFTER benefits from BASIC Medical Expense policy are exhausted and BEFORE benefits from a SUPPLEMENTAL Major Medical policy begin.
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- Accident & Health Agent Flashcards on H3: Medical Expense Insurance (Section I), created by Det Ferraris on 12/06/2013.
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- Det Ferraris
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