Chapter 2 - Insurance & Health Care Agencies
Vision Insurance
covers part or all of the fees imposed for optician and optometrist services, including annual checkups, glasses, contact lenses and surgery
Indemnity Plan
private health insurance that reimburses individuals for part or all of the expenses they incur from health care providers; individuals are free to decide whether to seek care from a primary care physician or a specialist
HIPPA (The Health Insurance Portability and Accountability Act)
prohibits insurance companies from denying health insurance coverage based on applicant's health status, medical history, previous claims, or disability
Agency for Health Care Policy & Research (AHCPR)
supports research "to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective service.
Maximum out-of-pocket expense
the TOTAL (max) amount a group member is required to pay out of pocket during a year.
Waiting Period
the period (in disability insurance) from the time you are disabled until you begin to receive disability income benefits
Health Departments
a part of government which focuses on issues related to the general health of the citizenry.
Disability Insurance
insurance that provides income to policyholders in the event that they become disabled (short or long-term). Short-term sometimes covered by the employer. Long-term is usually covered by the employee
Sources of Disability Insurance
-Individual disability insurance -Employer disability insurance -Insurance from Social Security -Income determined by amount of Social Security contributions you have made -Insurance from Workers' Compensation
Public Health Care Agencies
Government services that are tax supported.
Deductible
A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services
Co-payment
A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received
Co-insurance
A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid
Examples of Long-Term Care Insurance
Covers care in a nursing home, assisted living facility, or at home
Discount on charge arrangement
In a PPO, this is an arrangement in which the preferred provider organization agrees to pay a specific percentage of the health care provider's charges
Per diem rate arrangement
In a PPO, this is arrangement in which the preferred provider organization pays the provider a specific sum per day a patient is hospitalized
Examples of Private Health Care Plans
Indemnity Plan, HMOs, PPOs
Long-Term Care Insurance
Insurance that covers expenses associated with long-term health conditions that cause individuals to need help with everyday tasks; is very expensive
Examples of Government Health Care Plans
Medicare & Medicaid
Private Health Care
Not run by the government; opportunities—employs over 13 million workers in over 200 careers; is a 4 billion dollar per day industry.
Medicare
Provides health insurance to people over age 65; Part A covers inpatient care in hospitals or nursing facilities and some home health; Part B is optional coverage
Food & Drug Administration
a federal agency of the United States Department of Health and Human Services that oversees a majority of the organization's obligations involving food, drugs, cosmetics, animal food, dietary supplements, medical devices, biological goods and blood products.
Medicaid
a federal program that provides health care to the aged, blind, disabled, and need families with dependent children; Recipients must meet federal guidelines; Administered on a state-by-state basis
Preferred Provider Organization (PPO)
a health insurance plan that allows individuals to select a health care provider and covers most of the fees for services
Health Maintenance Organization (HMO)
a health insurance plan that covers health care services approved by doctors; a primary care physician provided general health services and refers patients to a specialist as necessary
Managed Health Care Plan
a health insurance policy under which individuals receive services from specific doctors or hospitals that are part of the plan
World Health Organization
a specialized agency of the United Nations (UN) that is concerned with international public health and focuses on improving the health of the world's people and preventing or controlling communicable diseases on a worldwide basis through various technical projects and programs.
Health Insurance
a type of insurance offered by private insurance companies & is a Critical component of financial planning
COBRA (Consolidated Omnibus Budget Reconciliation Act)
allows continuation of coverage provided through an employer's plan for 18 months if a job is lost in order to maintain health coverage.
Flexible Spending Accounts
an account established by the employer for the employee to use pretax income to pay for medical expenses. The employee must budget this out; not the employer. Funds cannot roll over.
Occupational Safety and Health Administration (OSHA)
assures safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.
Dental Insurance
covers part or all of the fees imposed for dental services, including annual checkups, orthodontics and oral surgery
US Dept of Health & Human Services (USDHHS)
department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services.
Private Health Insurance
health insurance that can be purchased from private insurance companies to provide coverage for health care expenses
Centers for Disease Control & Prevention (CDC)
leading national public health institute of the United States that protects public health and safety through the control and prevention of disease, injury, and disability.
Options for purchasing private health insurance
offered as a part of an employee benefit package (employer can pay all or can share cost of premium with employee), whereas self-employed individuals have to pay the entire cost
National Institute of Health (NIH)
the nation's medical research agency—supporting scientific studies that turn discovery into health.
Probationary Period
the period (in disability insurance) extending from the time your disability income application is approved until your coverage goes into effect
HIPPA Restrictions & Parameters
Health care access; Preventing health care fraud Tax-related health provisions; Application and enforcement of group health plan requirements; Revenue offsets
Types of Private Health Insurance
Hospital insurance, physician insurance, and surgical insurance