132172
Description
Flashcards by Det Ferraris, updated more than 1 year ago
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Created by Det Ferraris
almost 11 years ago
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| Question | Answer |
| Travel Accident | provides coverage for death or injury resulting from accidents occuring while a FARE-PAYING PASSENGER on a COMMON CARRIER |
| Specified Disease Insurance | supplemental insurance coverage for one or more specified catastrophic diseases or illnesses. (cancer, heart attack, stroke) FOOD IS NOT COVERED |
| Hospital Income Policy | pays a specific dollar amount on a daily, weekly or monthly basis while insured is confined to a hospital |
| Hospital Income Policy/Hospital Indemnity/Hospital Confinement | Hospital Income Policy/Hospital Indemnity/Hospital Confinement |
| Accident Only Policy | policy that provides coverage for the following when resulting from an ACCIDENT death, dismemberment, disability, hospital care, medical care |
| Accident | Unforseen and unintentional injury |
| Sickness | disease or illness |
| Credit Disability (Credit Health) | covers loan payments to a specific credit of the insured in the event of insureds disability Can be issued as INDIVIDUAL or GROUP policy |
| Credit Life | Policy that pays off outstanding loan balance to a creditor upon insured's death. Can be issued as Individual or Group policy. |
| Blanket Policy | a form of group health insurance where individuals are automatically covered by their affiliation with the group Usually the insured is not even reported to the insurer until a claim is made. |
| Major Risk Medical Insurance Program (MRMIP) | a STATE program that provides health insurance for Californians unable to obtain coverage in the individual health insurance market because of pre-existing conditions. |
| Managed Risk Medical Insurance Board duties include: | determind applicant eligibility, program coverage, contribution amounts, contracting with health plans, issuing rules and regulations |
| MRMIP Eligibility Requirements | Must be a resident of California, must have pre-existing condition, must NOT be eligible for medicare Part A or Part B |
| MRMIP | subscribers can enroll dependents on same application as long as dependent meets all the same eligibility requirements except that dependent NOT required to have pre-existing condition. |
| At Time, MRMIP may have a waiting list due to limited funding. When funding is limited, individuals who qualify for MRMIP will be placed on a waiting list until enrollment slots become available. | At Time, MRMIP may have a waiting list due to limited funding. When funding is limited, individuals who qualify for MRMIP will be placed on a waiting list until enrollment slots become available. |
| Waiting List | Placement on waiting list based on date a completed MRMIP app is received. |
| Tobacco Tax Fund helps fun MRMIP | Tobacco Tax Fund helps fun MRMIP |
| PPACA Overview | reforms certain aspects of private health insurance industry and public health insurance programs, increases coverage for pre-existing conditons and expands access to insurance to over 30 million Americans |
| Health Benefit Exchange | entitiy intended to create a more organized and competitive market by offering a choice of plans made available by commercial insurers, establishing common rules regarding offering and pricing, and providing information to help consumers better understand the options available to them. |
| CAs Health Benefit Exchange CANNOT deny someone with pre-existing condition | CAs Health Benefit Exchange CANNOT deny someone with pre-existing condition |
| CAs Health Benefit Exchange open to individuals and small employers (<100 employees) | CAs Health Benefit Exchange open to individuals and small employers (<100 employees) |
| Coverage for Adult Children up to 26 | Children can be covered under parents group health plan up to age 26 coverage CANNOT be restricted because of: financial dependency, residency, student status, employment status |
| Children under 19 cannot be declined health coverage due to pre-existing conditions (they are guaranteed issue of a policy) effective 9/23/2010, applies to new and grandfathered plans | Children under 19 cannot be declined health coverage due to pre-existing conditions (they are guaranteed issue of a policy) effective 9/23/2010, applies to new and grandfathered plans |
| Medical Loss Ratio | a metric used in managed health care and health insurance to measure medical costs as a percentage of premium revenues. |
| MLR= Claims/Total Premiums | MLR= Claims/Total Premiums |
| MLR Requirements | Large Group= 85% Small Group=80% Rebates required when MLR requirements not met |
| Access for Infants & Mothers (AIM) | state program that provides low cost health insurance coverage to pregnant women who do not have insurance to cover their pregnancy |
| Qualification for (AIM-Access for Infants & Mothers) | must be pregnany, but not >30 weeks, CA resident, must not be a recipient of Medical/Medicare, high copay of more than $500, must meet household income guidelines. |
| Healthy Families | state programs which provides low cost insurance that provides health, dental, and vision coverage to qualifying children Monthly premiums due, co-pay, $250 max for co-pays, |
| Qualifications | under 19 who live in Ca, not covered under employer-sponsored in 3 months, not be eligible/enrolled in no-cost medical, must meet citizenship or immigration rules, must meet household income guidelines How to apply? health E app |
| MRMIP= State Funded PCIP: Federally Funded | MRMIP= State Funded PCIP: Federally Funded |
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