H3: Medical Expense Insurance (Section I)

Det Ferraris
Flashcards by Det Ferraris, updated more than 1 year ago


Accident & Health Agent Flashcards on H3: Medical Expense Insurance (Section I), created by Det Ferraris on 06/12/2013.

Resource summary

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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