130376
Description
Flashcards by Det Ferraris, updated more than 1 year ago
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Created by Det Ferraris
over 13 years ago
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| Question | Answer |
| Indemnity Type Plans | Basic Medical Expense, Major Medical Expense |
| Indemnity type Plans | Insured chooses his own doctors, hospitals and other heath care providers |
| Indemnity 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) |
| 3 Basic Medical Expense Policies | Hospital Expense, Surgical Expense, Physicians Visit Expense |
| Hospital Expense | Hospital Room and Board, Lab/Xrays Charges, Operating Room |
| Surgical Expense | primary surgeon Fee, 2nd opinion, asst surgeon/anesthesiologists |
| Physicians Visit Expense | Doctor hospital visits, doctor office visits |
| Possible Benefit Structures for Surgical Expense Policies | Schedule of Fees, UCR (Usual, customary, reasonable) insurer pays fees most consistent with those in a particular geographic region, Relative Value Units |
| First $ Coverage | No deductibles, copays, coinsurance |
| Methods of Reimbursements | Reimbursements, Indemnity, Service |
| Reimbursement | insurer pays the actual cost or % of actual cost for covered procedures and services, regardless of how much they cost. |
| Indemnity | insurer pays a specified amount per day for a specified maximum number of days |
| Service | policy benefits are expressed in terms of the services provided rather than dollar maximums |
| 2 Major Medical Expense Policies | Comprehensive and Supplemental |
| Comprehensive | a single major medical contract that covers most medical expenses |
| restoration of benefits | provision that allows policy's Life time Max to be restored. It might require insured to periodically prove insurability or might automatically reset each year. |
| Supplemental | a type of major medical policy that is purchased in conjuction with one or more Basic Medical Expense polices to provide broader coverage. |
| Basic + Supplemental= Comprehensive | Basic + Supplemental= Comprehensive |
| Corridor Deductibles | a 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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