Chapter 09 - Insuring Your Health

10) Average Nursing Home Cost Long-term care can become extremely expensive if it continues for even a short amount of time. A recent study found that, on average, the annual cost for nursing home residency is $_______________. The average stay in a nursing home is _______________. If you or a loved one enter a nursing home today, according to these figures, the total nursing home cost will be $_______________.

- $97,455 - 2 years - $194,910

9) Terms of coverage for medical expense plans Continuation of group coverage (COBRA) Except in the case of dismissal from a job for gross misconduct, this provision allows former employees to remain covered under their group plans from work for up to ___ months after termination as long as they _______________________________. After COBRA expires, most insureds ________ the opportunity to convert the group policy to an individual policy.

- 18 - pay the premiums on time - have

12) Social Security Disability Benefits Alex recently sustained an injury that is unrelated to his work. He expects to be disabled for some time and has contacted the Social Security Administration to file a claim for disability benefits. Alex has always heard about Social Security disability and looks forward to the relief it will deliver. Alex was shocked to learn the terms of qualifying for benefits: Alex expects to be disabled for 25 months. His benefits will be for _____ months for a total of $____________. Alex _______ receive benefits because he _______ be disabled long enough to qualify for them. (Hint: If Alex is not eligible for benefits, enter a "0" for the months and total benefit numeric entry boxes.)

- 20 - $50,000 - will - will

11) Long-term care insurance provisions and costs In conclusion: It's important to learn how to choose the right policy so you'll obtain one with _____________________ coverage at a cost that __________________________.

- adequate - you can afford

9) Terms of coverage for medical expense plans Mental illness Mental illness is _______________ of the list of sicknesses requiring long-term hospitalization. Many health insurance policies provide ___________ coverage for mental illness than other sicknesses.

- at the top - less

9) Terms of coverage for medical expense plans Cancellation The most protective plan is one that _____________ an insurer to cancel your coverage as long as you _____________________________.

- does not allow - pay the premiums

14) The cost of premiums for men and women The cost of premiums for disability income insurance with the same terms is _________ for a woman than a man. A woman will pay approximately the same premium as a man her age for coverage with __________ restrictions than the man's. The reason is that ________________________________________________________________.

- more - more - women's life expectancies are longer than men's

10) Long-Term Care Is an Important Part of Health Insurance and Retirement Planning Where can long-term care be provided? Check all that apply

- the patient's house - an assisted living community - a nursing home

7) Physician expenses

Covers cost of doctor visits, including consultations with specialists

10) Long-Term Care Is an Important Part of Health Insurance and Retirement Planning Even if you are currently healthy, you probably know people, perhaps even family members, who require assistance to simply live on a day to day basis. The __________ you are, the ________ likely you'll need help sooner rather than later. Keep in mind, though, that the chances you'll require more than a year of nursing home care before you reach the age of 65 are about 1 in ____. Should you need such care before you're 65, it would more likely be due to ______________________________________ than ______________________________________.

- older - more - 33 - a serious illness or accident - the aging process

9) Terms of coverage for medical expense plans Pregnancy and abortion A plan that covers all medical expenses related to pregnancy and abortion, including __________________, is considered ____________. The most restrictive policy

- sick-leave pay - liberal - doesn't cover any costs associated with pregnancy or abortion

9) Terms of coverage for medical expense plans Persons and places covered You have a named-insured policy. You are most likely _________________________________. The most recent health reform act allows young adults to remain on their parents' insurance until they are ____ years old.

- single with no dependents - 26

4) Current government health insurance plans In the United States, health care programs may be provided by the federal government, the governments of individual states, or some combination of both. It is important to know who is eligible, as well as the services provided by each of these programs. Read each of the following statements and indicate whether it applies to Medicare, Medicaid, or workers' compensation programs. 1) Under this program, employers who file the most claims pay the highest rates, and the rates can vary from state to state. 2) Each state determines its eligibility standards and the types of coverage provided. 3) Part C of the program, which provides vision, hearing, dental, general checkup and wellness benefits, is frequently paid for by both the federal government and the premiums paid by members.

1) Workers' compensation 2) Medicaid 3) Medicare

7) Hospitalization

Covers semiprivate room rate including meals and nursing care; number of admission days usually limited

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Yvette has had an illness and an accident during the year. Her combined out-of-pocket expense for both incidents was $1,000. The insurance company will now start to pay some of her medical expenses. What does the $1,000 represent?

Deductible

8) Valerie, a veterinarian, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Valerie was injured was injured by lightening while delivering a calf in a farmer's field. She spent 5 days in the hospital in a room that cost $600 per day, incurred $5,500 for other medical expenses, and $20,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions Based on this data, the total cost to the insurance company is $________________, while the out-of-pocket cost to Valerie is $_________________.

- $20,800 - $6,700

5) Health care cost risk Today, adequate health care insurance for a serious illness or accident is estimated to be at least $________________ and for a very lengthy illness or disability, up to $__________________. Coverage for lost income is generally computed at __________________ of monthly earnings in order to provide benefits that approximate ___________ pay.

- $300,000 - $1,000,000 - 60% to 75% - take-home

1) Disability Income Insurance

This type of insurance provides families with weekly or monthly payments to replace income when the insured is unable to work because of a covered illness, injury, or disease. is designed to provide families with weekly or monthly payments to replace income when the insured is unable to work because of a covered illness, injury, or disease. While this insurance is greatly needed, it is often neglected and not available when or in the amount needed. This is particularly true given the constraints on the availability of Social Security benefits.

7) Comprehensive major medical insurance

Usually written under a group contract, includes coverage for hospitalization, surgery, physicians, and major medical protection in a single policy

8) Assume that the hospital changed its payment policy to make the patient responsible for the difference between the hospital's room rate and the insurance company's responsibility ($600 per day versus $400 per day). By how much would Valerie's out-of-pocket cost for her hospital room change due in hospital billing ?

Valerie's costs would increase by $1,000.

10) Average Nursing Home Cost Becoming familiar with what long-term care involves, and the options available for providing it, will enable you to plan for your own future or perhaps help others, particularly older friends or relatives, plan for their futures. It will most likely be emotionally, mentally, and financially easier to make wise decisions about long-term care _____________ it becomes necessary.

before

9) Terms of coverage for medical expense plans What's in and what's out? When shopping for a health insurance plan, find out about different plans' contract provisions, in case they

would restrict or even exclude coverage that's important to you

8) Terms of payment for medical expense plans Ginny, a sales representative, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her job, provides the following coverage: Last month, Ginny was injured was grazed by a car while crossing the street. She spent 2 days in the hospital in a room that cost $450 per day, incurred $2,000 for other medical expenses, and $18,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions How much did Ginny save by having her medical insurance policy? $______________.

$15,680

2) Benefit of health insurance - A cautionary tale In 2016, Clancy became responsible for providing his own health insurance. He obtained suitable coverage and paid annual premiums as shown in the following table. Compute Clancy's total premiums: Clancy's Premium: 1) Total __________________

$19,056

2) Benefit of health insurance - A cautionary tale In 2016, Hilary became responsible for providing her own health insurance. She obtained suitable coverage and paid annual premiums as shown in the following table. Compute Hilary's total premiums: Hilary's Premium: 1) Total __________________

$19,056

8) Valerie, a veterinarian, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Valerie was injured was injured by lightening while delivering a calf in a farmer's field. She spent 5 days in the hospital in a room that cost $600 per day, incurred $5,500 for other medical expenses, and $20,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions How much did Valerie save by having her medical insurance policy? $_________________.

$20,800

8) Terms of payment for medical expense plans Becky, a restaurant owner, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Becky was injured during a severe grease file in her restaurant. She spent 3 days in the hospital in a room that cost $750 per day, incurred $4,000 for other medical expenses, and $22,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions How much did Becky save by having her medical insurance policy?

$21,600

10) Long-Term Care Is an Important Part of Health Insurance and Retirement Planning No matter what your age, it can be hard to imagine that you may no longer be able to care for yourself. Long-term care includes, but is not limited to, providing medical and personal care (other than hospitalization) to people with __________________ medical conditions such as __________________

- chronic - dementia

8) Terms of payment for medical expense plans Ginny, a sales representative, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her job, provides the following coverage: Last month, Ginny was injured was grazed by a car while crossing the street. She spent 2 days in the hospital in a room that cost $450 per day, incurred $2,000 for other medical expenses, and $18,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions Based on this data, the total cost to the insurance company is $_______________, while the out-of-pocket cost to Ginny is $_______________.

- $15,680 - $4,920

2) Benefit of health insurance - A cautionary tale In 2016, Hilary became responsible for providing her own health insurance. She obtained suitable coverage and paid annual premiums as shown in the following table. Some employers pay part or all of the health insurance premiums for employees who are enrolled in one of the company's sponsored plans. Assume that during the same time period that Hilary paid for her premiums in full that she had, instead, worked for a firm that paid 75% of her premiums for the same coverage. Instead of paying premiums of $______________ over the years, Hilary would have paid $____________ and saved $_______________.

- $19,056 - $4,764.0 - $14,292

2) Benefit of health insurance - A cautionary tale In 2016, Clancy became responsible for providing his own health insurance. He obtained suitable coverage and paid annual premiums as shown in the following table. Some employers pay part or all of the health insurance premiums for employees who are enrolled in one of the company's sponsored plans. Assume that during the same time period that Clancy paid for his premiums in full that he had, instead, worked for a firm that paid 50% of his premiums for the same coverage. Instead of paying premiums of $___________ over the years, Clancy would have paid $____________ and saved $_____________.

- $19,056 - $9,529.0 - $9,528

8) Terms of payment for medical expense plans Becky, a restaurant owner, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Becky was injured during a severe grease file in her restaurant. She spent 3 days in the hospital in a room that cost $750 per day, incurred $4,000 for other medical expenses, and $22,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions Based on this data, the total cost to the insurance company is $______________, while the out-of-pocket cost to Becky is $_____________.

- $21,600 - $5,900

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Clancy enjoyed good health during those years. Because he had no reason to think that would change, by the end of 2018, Clancy was considering dropping his health insurance coverage. After all, he could think of a lot of other uses for the thousands of dollars he spent each year on increasing premiums. Clancy decided to pay premiums for another year but planned to take another look at his health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Clancy accepted an invitation from friends to go snowboarding. Clancy did everything right: took a lesson, stayed on trails well within his skill level, and maintained an awareness of people and objects near him. Even though he thought it was a bit dorky to wear wrist guards and a helmet, his friends insisted that he take standard and reasonable safety measures. Clancy was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Clancy. Clancy was injured and taken to the nearest hospital by ambulance. Clancy's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of his head injury. Clancy spent a couple of days in intensive care. Fortunately, he didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Clancy was in good health, his recovery was complete. Clancy returned to full function in about six months. Soon after Clancy returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Clancy also had to have physical therapy for his wrist and elbow. His total medical expenses were $30,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. If Clancy had canceled his health insurance at the end of 2018, his out-of-pocket expenses for the accident would have been $____________. In this case, did Clancy benefit from having health insurance?

- $30,000 - Yes

9) Terms of coverage for medical expense plans Preexisting conditions If you need a new insurance plan and have a chronic condition, continued coverage for that condition is more likely under __________________ plan. For individuals, one of the ______________ of the Affordable Care Act is that it ______________ exclusion from coverage for preexisting conditions. This new provision could cause ____________ premiums.

- an group - benefits - prevents - higher

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Hilary enjoyed good health during those years. Because she had no reason to think that would change, by the end of 2018, Hilary was considering dropping her health insurance coverage. After all, she could think of a lot of other uses for the thousands of dollars she spent each year on increasing premiums. Hilary decided to pay premiums for another year but planned to take another look at her health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Hilary accepted an invitation from friends to go snowboarding. Hilary did everything right: took a lesson, stayed on trails well within her skill level, and maintained an awareness of people and objects near her. Even though she thought it was a bit dorky to wear wrist guards and a helmet, her friends insisted that she take standard and reasonable safety measures. Hilary was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Hilary. Hilary was injured and taken to the nearest hospital by ambulance. Hilary's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of her head injury. Hilary spent a couple of days in intensive care. Fortunately, she didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Hilary was in good health, her recovery was complete. Hilary returned to full function in about six months. Soon after Hilary returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Hilary also had to have physical therapy for her wrist and elbow. Her total medical expenses were $35,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. If Hilary had canceled her health insurance at the end of 2018, her out-of-pocket expenses for the accident would have been $______________. In this case, did Hilary benefit from having health insurance? ______

- $35,000 - Yes

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Clancy enjoyed good health during those years. Because he had no reason to think that would change, by the end of 2018, Clancy was considering dropping his health insurance coverage. After all, he could think of a lot of other uses for the thousands of dollars he spent each year on increasing premiums. Clancy decided to pay premiums for another year but planned to take another look at his health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Clancy accepted an invitation from friends to go snowboarding. Clancy did everything right: took a lesson, stayed on trails well within his skill level, and maintained an awareness of people and objects near him. Even though he thought it was a bit dorky to wear wrist guards and a helmet, his friends insisted that he take standard and reasonable safety measures. Clancy was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Clancy. Clancy was injured and taken to the nearest hospital by ambulance. Clancy's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of his head injury. Clancy spent a couple of days in intensive care. Fortunately, he didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Clancy was in good health, his recovery was complete. Clancy returned to full function in about six months. Soon after Clancy returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Clancy also had to have physical therapy for his wrist and elbow. His total medical expenses were $30,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. His out-of-pocket expenses for the accident of $__________ plus the 2019 insurance premiums of $___________ totaled $____________.

- $4,500 - $5,049 - $9,549

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Hilary enjoyed good health during those years. Because she had no reason to think that would change, by the end of 2018, Hilary was considering dropping her health insurance coverage. After all, she could think of a lot of other uses for the thousands of dollars she spent each year on increasing premiums. Hilary decided to pay premiums for another year but planned to take another look at her health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Hilary accepted an invitation from friends to go snowboarding. Hilary did everything right: took a lesson, stayed on trails well within her skill level, and maintained an awareness of people and objects near her. Even though she thought it was a bit dorky to wear wrist guards and a helmet, her friends insisted that she take standard and reasonable safety measures. Hilary was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Hilary. Hilary was injured and taken to the nearest hospital by ambulance. Hilary's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of her head injury. Hilary spent a couple of days in intensive care. Fortunately, she didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Hilary was in good health, her recovery was complete. Hilary returned to full function in about six months. Soon after Hilary returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Hilary also had to have physical therapy for her wrist and elbow. Her total medical expenses were $35,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. Her out-of-pocket expenses for the accident of $__________ plus the 2019 insurance premiums of $_________ totaled $_____________.

- $7,000 - $5,049 - $12,049

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Clancy enjoyed good health during those years. Because he had no reason to think that would change, by the end of 2018, Clancy was considering dropping his health insurance coverage. After all, he could think of a lot of other uses for the thousands of dollars he spent each year on increasing premiums. Clancy decided to pay premiums for another year but planned to take another look at his health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Clancy accepted an invitation from friends to go snowboarding. Clancy did everything right: took a lesson, stayed on trails well within his skill level, and maintained an awareness of people and objects near him. Even though he thought it was a bit dorky to wear wrist guards and a helmet, his friends insisted that he take standard and reasonable safety measures. Clancy was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Clancy. Clancy was injured and taken to the nearest hospital by ambulance. Clancy's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of his head injury. Clancy spent a couple of days in intensive care. Fortunately, he didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Clancy was in good health, his recovery was complete. Clancy returned to full function in about six months. Soon after Clancy returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Clancy also had to have physical therapy for his wrist and elbow. His total medical expenses were $30,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. Overall, Clancy's insurance paid ___% of the total medical expenses, thus making him responsible for 15% of the expenses, or $___________. Clancy's insurance paid $_____________.

- 15% - $4,500 - $25,500

6) So Many Options, So Many Types of Plans Having a wide range of choices among the doctors, hospitals, and other health services she may want to use is very important to Alyssa. All other factors being equal, Alyssa is willing to pay more for ____________________. Alyssa and her spouse plan to start a family in the near future. They are concerned about maternity and pediatric care. Brian, on the other hand, has a risky lifestyle. He is concerned about emergency treatment and physical rehabilitation. While they have _________________ concerns, they should follow _______________ steps to make sure the plans they consider adequately cover their individual requirements. Alyssa has narrowed down her choices to two managed care networks. She ___________ check their accreditation. Significant changes in membership numbers ______________ be investigated in order to assess the plans' reputations and stability. All other factors being equal, Alyssa will probably favor the network in which _______ of her current providers participate than in the other network. Brian is young and healthy. Brian will probably take ________ risk when selecting his health insurance plan than his friend who, although the same age as Brian, has a history of poor health.

- an indemnity - different - the same - should - should - more - more

2) Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Hilary enjoyed good health during those years. Because she had no reason to think that would change, by the end of 2018, Hilary was considering dropping her health insurance coverage. After all, she could think of a lot of other uses for the thousands of dollars she spent each year on increasing premiums. Hilary decided to pay premiums for another year but planned to take another look at her health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Hilary accepted an invitation from friends to go snowboarding. Hilary did everything right: took a lesson, stayed on trails well within her skill level, and maintained an awareness of people and objects near her. Even though she thought it was a bit dorky to wear wrist guards and a helmet, her friends insisted that she take standard and reasonable safety measures. Hilary was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Hilary. Hilary was injured and taken to the nearest hospital by ambulance. Hilary's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of her head injury. Hilary spent a couple of days in intensive care. Fortunately, she didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Hilary was in good health, her recovery was complete. Hilary returned to full function in about six months. Soon after Hilary returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Hilary also had to have physical therapy for her wrist and elbow. Her total medical expenses were $35,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. Overall, Hilary's insurance paid 80% of the total medical expenses, thus making her responsible for ___% of the expenses, or $____________. Hilary's insurance paid $______________.

- 20% - $7,000 - $28,000

6) So Many Options, So Many Types of Plans Susan, who just accepted employment with a firm that offers a cafeteria-style benefit plan, has called you for advice and answers to questions about consumer directed health plans benefit plans. Which of the following statements regarding cafeteria benefit plans is correct? Check all that apply.

- In offering these plans, employers generally establish a dollar limit that they allocate for spending by each worker on his or her selected benefits. - A cafeteria plan offers an employee an opportunity to select the benefits that best fit the employee's lifestyle and financial circumstances. - The benefits frequently offered through flexible benefit plans include several types of health, life, and disability insurance.

2)Except for an occasional minor illness requiring a doctor's attention, a drug prescription, and periodic, routine tests, Clancy enjoyed good health during those years. Because he had no reason to think that would change, by the end of 2018, Clancy was considering dropping his health insurance coverage. After all, he could think of a lot of other uses for the thousands of dollars he spent each year on increasing premiums. Clancy decided to pay premiums for another year but planned to take another look at his health care plan at the end of 2019. It Could Happen to You, It Could Happen to Me In December 2019, Clancy accepted an invitation from friends to go snowboarding. Clancy did everything right: took a lesson, stayed on trails well within his skill level, and maintained an awareness of people and objects near him. Even though he thought it was a bit dorky to wear wrist guards and a helmet, his friends insisted that he take standard and reasonable safety measures. Clancy was enjoying the day when, from out of nowhere (actually, the woods), came an out of control skier who ran into Clancy. Clancy was injured and taken to the nearest hospital by ambulance. Clancy's injuries included a broken wrist and elbow as well as cuts and bruises. Of biggest concern was the uncertainty of his head injury. Clancy spent a couple of days in intensive care. Fortunately, he didn't have a broken skull, but did have a concussion. Surgery was performed to repair the broken wrist and elbow. Since Clancy was in good health, his recovery was complete. Clancy returned to full function in about six months. Soon after Clancy returned home, however, the medical bills for the ambulance, emergency room, intensive care, medications, doctors, tests, and other services arrived. Clancy also had to have physical therapy for his wrist and elbow. His total medical expenses were $30,000. It was time to find out if all those premiums paid since 2016 would pay off for just one, albeit dramatic, incident. Benefit of health insurance - A cautionary tale In 2016, Hilary became responsible for providing her own health insurance. She obtained suitable coverage and paid annual premiums as shown in the following table. What are reasonable morals of the story? Check all that apply. What are reasonable morals of the story? Check all that apply.

- It can be financially risky to go without health insurance. - Think long and hard about the best tradeoff of coverage and cost in a health care plan. - Your health can change in an instant.

5) Health care cost risk Part of figuring out what kind of overall health care plan is best for you includes knowing the costs that health care insurance covers. In the event of an illness or accident, health care insurance protection is designed to cover which of the following costs? Check all that apply.

- Loss of income - Rehabilitation - Loss of household services - Medical care

2) Benefit of health insurance - A cautionary tale In 2016, Clancy became responsible for providing his own health insurance. He obtained suitable coverage and paid annual premiums as shown in the following table. What are reasonable morals of the story? Check all that apply.

- Think long and hard about the best tradeoff of coverage and cost in a health care plan. - It can be financially risky to go without health insurance.

7) Vocabulary - Types of medical expense coverage Why is it important to be familiar with the variety of medical expenses covered by health insurance plans? Check all that apply.

- To minimize the chances of unpleasant surprises, particularly regarding gaps in—or lack of—coverage - To make cost-effective treatment decisions - To avoid buying coverage so unlikely to be used that it's not worth the cost - To obtain the best coverage for the lowest cost

14) Disability policies include probationary and waiting periods. You plan to take a vacation to go helicopter skiing and will be sure to purchase your disability income insurance policy before the trip. You should also make sure to take your vacation ____________ the policy's _________________________ period expires because if you get hurt during that time, you will ______________________________________________. You've had a disability income insurance policy for many years. You have an emergency savings account that would support you for three months. If you lose income due to injury or illness, you plan to use these funds until the 90-day ________________ period expires, after which you ____________ begin receiving benefits from your disability income insurance policy. Probationary and waiting periods are similar in that they help keep costs down, but they also differ. Benefit payments—both current and future—are prohibited for injuries or illnesses that occur in the __________________________ period. This period is usually _______________________. Benefit payments for injuries or illnesses that occur after the _______________________ period ________ made when the ________________ period has elapsed.

- after - probationary - not receive benefits at all - waiting - would - probationary - 7 to 30 days - probationary - are - waiting

11) Long-term care insurance provisions and costs Two policies you really like are identical except one offers a daily maximum benefit of $300 and the other's daily benefit is $750. The premium for the $300 provision will cost ___________________ the $750 provision. If you select the $300 provision and need to collect benefits, you will pay ________ out-of-pocket expense than you would for the $750 provision. You've decided to limit the duration of your benefit payments, should you even need them, to a 4 year plan, which will cost _______________ a lifetime plan. Besides the specific premium costs associated with the length of the benefit period, you based your decision on the fact that the average nursing home stay is ________________ the term of the policy you selected. That average is ____ years.Most policies have a waiting period before benefits begin to be paid (not retroactively). The longer the waiting period, the ____________ the premium. The policy you're considering offers inflation protection. Since it typically adds ___________________ to the basic premium, you've decided not to buy the protection.In addition to being able to afford the premium for a policy, you need to determine that you _______ pay the out-of-pocket expenses not covered by insurance using your liquid assets. You were glad to learn that preexisting condition clauses are now ____________________- by the Patient Protection and Affordable Care Act. You'll need to be sure to buy a policy with __________________________ renewability clause so an insurer __________________ refuse to renew your coverage.

- less than - more - less than - less than - 2 - lower - 25% to 40% - can - outlawed - a guaranteed - cannot

13) Disability Income Insurance Can Replace Your Earnings if You Can't Work All insurance requires premium payments and, as a general rule, the more generous the provisions, the ___________ expensive the premiums. Taking the time to gather information about your sources of disability income and doing some simple arithmetic not only helps you determine the amount of coverage you'd need, but could reveal sources you forgot or didn't know about. The more you already have available, the _________ coverage you have to purchase, and the less coverage you have to purchase, the ___________ the premium you have to pay. To arrive at the amount of disability income you would have to provide for yourself, you'll compare your earnings to the benefits you'd receive from government, employer, or private programs. The _____________________ is how much you'd be short—and it is extremely unlikely that you wouldn't be short.

- more - less - lower - difference

14) Noncancellation and waiver of premium clauses A friend of yours has a great job that pays well. He plans to work all his life. His only source of income is his paycheck. He takes trips and enjoys other extras in life. Now that you know that becoming disabled can bring financial ruin, you'll strongly recommend that your friend purchase disability income insurance. It is most important that your friend's policy includes a ____________________________ clause. You explain to your friend that a _________________________ clause would relieve him of the responsibility of continuing to pay the insurance premiums when collecting benefits. But a _____________________________ clause means he would always have coverage. If the insurance company canceled his policy and he became disabled, he'd lose a lot ________ than he would if he collected benefits and had to continue to pay premiums.

- noncancellation - waiver of premium - noncancellation - more

11) Long-term care insurance provisions and costs Many long-term care policies focus more on benefits for ___________________________________________________________ probably because of ______________ cost. In either case, benefits should cover ___________________________________________________________ care. Your financial advisor recommends purchasing a policy that provides benefits for care ________________________________________________ because _____________________________________________________________________________________.Because you are cost conscious, you will buy a plan ______________________________________ for eligibility for coverage. Your plan will pay benefits _____________________________________________________________________________. You will apply your cost conscious nature to determine your daily maximum benefit, how long your benefit will continue, obtaining inflation protection, and the waiting period.

- nursing home care rather than at home care - higher - services for skilled, intermediate, and custodial - in both a nursing home and in your residence - it is very difficult to predict the extent of care you may need as time goes by - with gatekeeper provisions to test - only after you have failed to perform a number of defined activities of daily living

14) Selecting a Disability Income Insurance Plan You love your job and if you become disabled don't want to do any other job. Yet, you'll need an income. Even though it will cost you more, you will buy a policy with a definition of disability of _____________________________. The cost is more because the insurer has _______ flexibility when determining if you're eligible for benefits. When you shopped for a disability income insurance plan, the likelihood of finding a plan that would pay 95% of your gross income was ____________________. You found that the usual range of gross pay that's covered with disability income insurance is ___________________ because the _____________ percentages could encourage some people to _______________________________. In many cases, these people could then collect ___________ than their ______________________ pay from their jobs. Limiting the amount of disability benefits to these percentages usually covers necessities adequately and often ____________________________________________________ in their recoveries enough to return to work and thus return to their full income level.

- own occupation - less - very unlikely - 60% to 70% - higher - fake an injury or illness - more - take-home - encourages patients to actively participate

6) So Many Options, So Many Types of Plans Alyssa has a job. The first place she should look for health care coverage is __________________________________ because the costs will probably be the _________ for the ________ generous terms and coverage. Brian does not have a job. He is a member of the alumni association of his alma mater. Brian will probably find better coverage for a lower cost through plans offered by ______________________________ because __________ plans spread the costs and risks among more people than __________________ plans do.To begin their research, Alyssa and Brian should look at ______________________________________________ in order to ____________________.

- the company she works for - lowest - most - his alumni association - group - individual - indemnity and managed care plans - be thorough

2) Benefit of health insurance - A cautionary tale In 2016, Hilary became responsible for providing her own health insurance. She obtained suitable coverage and paid annual premiums as shown in the following table. In this case, Hilary's out-of-pocket expenses specific to her snowboarding accident would have been ______________ they actually were because ____________________________________________________.

- the same as - her employer only contributes to premiums

2) Benefit of health insurance - A cautionary tale In 2016, Clancy became responsible for providing his own health insurance. He obtained suitable coverage and paid annual premiums as shown in the following table. In this case, Clancy's out-of-pocket expenses specific to his snowboarding accident would have been _________________ they actually were because ____________________________________________________.

- the same as - his employer only contributes to premiums

14) How long should you receive benefits? Upon retirement at 65, you expect to collect a pension, Social Security, and draw on your IRA. Your best friend works as a consultant, doesn't report income, and has a small IRA. You will most likely buy a disability income insurance policy that covers you ________________________________. You suggest that your friend purchase a policy that provides coverage _________________________. Your choice and suggestion are based on that fact that disability income insurance provides funds when income is lost due to illness or injury. If you become disabled after you retire you _____________ lose your pension, Social Security, or IRA income. If your friend becomes disabled, the small IRA is ____________ to be sufficient to provide for basic necessities. Additional income ______ be necessary to pay the simplest expenses.

- until you retire at 65 - for a lifetime - will not - unlikely - will

13) Computing Monthly Disability Needs Gilberto wants to estimate his monthly disability income needs in case he is injured or ill and can't work for an extended period of time. Gilberto has gathered the following figures, on a current, per-month basis. - Gilberto's gross pay is $3,375 and take-home pay is $2,500. - If Gilberto is eligible for Social Security disability, his benefit will be $1,250. Gilberto expects to be disabled for 14 months. - As an armed services veteran, Gilberto has discovered that he would receive $500 frEstimated disability benefits needed:om the government. His payments would begin immediately. - Gilberto would receive $250 in company disability benefits. His payments would begin immediately. - Gilberto would receive $500 from his group disability policy. His payments would begin immediately. Complete the following table for the third month of Gilberto's disability. 1) Social Security benefits 2) Other government program benefits 3) Company disability benefits 4) Group disability policy benefits 5) Total existing disability benefits - _____________ pay - $____________ 6) Estimated disability benefits needed:

1) $0 2) $500 3) $250 4) $500 5) $1,250 - Take-home - $2,500 6) $1,250

13) Computing Monthly Disability Needs Rajiv wants to estimate his monthly disability income needs in case he is injured or ill and can't work for an extended period of time. Rajiv has gathered the following figures, on a current, per-month basis. - Rajiv's gross pay is $4,725 and take-home pay is $3,500. - If Rajiv is eligible for Social Security disability, his benefit will be $1,400. Rajiv expects to be disabled for 11 months. - As an armed services veteran, Rajiv has discovered that he would receive $700 from the government. His payments would begin immediately. - Rajiv's company does not provide disability benefits. - Rajiv would receive $700 from his group disability policy. His payments would begin immediately. Complete the following table for the ninth month of Rajiv's disability. 1) Social Security benefits 2) Other government program benefits 3) Company disability benefits 4) Group disability policy benefits 5) Total existing disability benefits - _____________ pay - $____________ 6) Estimated disability benefits needed:

1) $0 2) $700 3) $0 4) $700 5) $1,400 - Take-home - $3,500 6) $2,100

8) Terms of payment for medical expense plans Becky, a restaurant owner, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Becky was injured during a severe grease file in her restaurant. She spent 3 days in the hospital in a room that cost $750 per day, incurred $4,000 for other medical expenses, and $22,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions 1) Hospital charges - Total Claim 2) Surgery costs - Policy Limit 3) Surgery costs - Total Claim 4) Other medical costs - Policy Limit 5) Other medical costs - Total Claim 6) Rehabilitation and therapy costs - Policy Limit 7) Rehabilitation and therapy costs - Total Claim 8) Deductible - Policy Limit 9) Co-insurance percentage - Policy Limit 10) Total cost of claim - Total Claim

1) $1,500 2) $25,000 3) $22,000 4) $5,000 5) $4,000 6) $25,000 7) $0 8) $500 9) 80% 10) $27,500

13) Computing Monthly Disability Needs Crystal wants to estimate her monthly disability income needs in case she is injured or ill and can't work for an extended period of time. Crystal has gathered the following figures, on a current, per-month basis. - Crystal's gross pay is $5,400 and take-home pay is $4,000. - If Crystal is eligible for Social Security disability, her benefit will be $1,600. Crystal expects to be disabled for 12 months. - As an armed services veteran, Crystal has discovered that she would receive $800 from the government. Her payments would begin immediately. - Crystal would receive $400 in company disability benefits. Her payments would begin immediately. - Crystal would receive $800 from her group disability policy. Her payments would begin immediately. Complete the following table for the tenth month of Crystal's disability. 1) Social Security benefits 2) Other government program benefits 3) Company disability benefits 4) Group disability policy benefits 5) Total existing disability benefits - _____________ pay - $____________ 6) Estimated disability benefits needed:

1) $1,600 2) $800 3) $400 4) $800 5) $3,600 - Take-home - $4,000 6) $400

8) Terms of payment for medical expense plans Ginny, a sales representative, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her job, provides the following coverage: Last month, Ginny was injured was grazed by a car while crossing the street. She spent 2 days in the hospital in a room that cost $450 per day, incurred $2,000 for other medical expenses, and $18,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions 1) Hospital charges - Total Claim 2) Surgery costs - Policy Limit 3) Surgery costs - Total Claim 4) Other medical costs - Policy Limit 5) Other medical costs - Total Claim 6) Rehabilitation and therapy costs - Policy Limit 7) Rehabilitation and therapy costs - Total Claim 8) Deductible - Policy Limit 9) Co-insurance percentage - Policy Limit 10) Total cost of claim - Total Claim

1) $2,000 2) $40,000 3) $20,000 4) $7,500 5) $5,500 6) $25,000 7) $0 8) $1,500 9) 80% 10) $27,500

8) Terms of payment for medical expense plans Valerie, a veterinarian, is 24 years old and has owned a major medical insurance policy for three years. The policy, which she purchased through her trade association, provides the following coverage: Last month, Valerie was injured was injured by lightening while delivering a calf in a farmer's field. She spent 5 days in the hospital in a room that cost $600 per day, incurred $5,500 for other medical expenses, and $20,000 in surgical expenses. Given these claim costs, complete the following table and answer the related questions 1) Hospital charges - Total Claim 2) Surgery costs - Policy Limit 3) Surgery costs - Total Claim 4) Other medical costs - Policy Limit 5) Other medical costs - Total Claim 6) Rehabilitation and therapy costs - Policy Limit 7) Rehabilitation and therapy costs - Total Claim 8) Deductible - Policy Limit 9) Co-insurance percentage - Policy Limit 10) Total cost of claim - Total Claim

1) $2,000 2) $40,000 3) $20,000 4) $7,500 5) $5,500 6) $25,000 7) $0 8) $1,500 9) 80% 10) $27,500

12) Social Security Disability Benefits Alex recently sustained an injury that is unrelated to his work. He expects to be disabled for some time and has contacted the Social Security Administration to file a claim for disability benefits. Alex has always heard about Social Security disability and looks forward to the relief it will deliver. Alex was shocked to learn the terms of qualifying for benefits: 1) First, he must be _______ disabled. 2) Second, his disability must be anticipated to be at least __________________. 3) Third, he must be unable to ______________________________. 4) Fourth, if he satisfies the preceding requirements, his benefit is $2,500 per month, but he must wait _________________ for payments to begin. The monthly payments ____________ retroactive.

1) 100% 2) one year 3) do any job at all 4) - five months - are not

6) So Many Options, So Many Types of Plans Consumer-directed benefit plans can include accounts that exhibit differences in their tax status, portability (in the event you leave your job), and benefit carryover from year-to-year. To better compare the differences between health reimbursement accounts (HRAs), health savings accounts (HSAs), and flexible savings accounts (FSAs), complete the following table by indicating the attributes of each type of account. Check all that apply. 1) Unspent account balances can be carried over from year to year 2) Account balances are funded only by employees 3) If you leave your employer, the funds will move with you 4) An employee does not pay taxes on account balances

1) HRA and HSA 2) FSA 3) FSA and HSA 4) FSA, HRA, and HSA

6) So Many Options, So Many Types of Plans Consumer-directed benefit plans can include accounts that exhibit differences in their tax status, portability (in the event you leave your job), and benefit carryover from year-to-year. To better compare the differences between health reimbursement accounts (HRAs), health savings accounts (HSAs), and flexible savings accounts (FSAs), complete the following table by indicating the attributes of each type of account. Check all that apply. 1) Unspent account balances can be carried over from year to year 2) Account balances can be funded by the employer, the employee, or both 3) If you leave your employer, the funds remain with the employer 4) An employee pays taxes on account balances

1) HRA and HSA 2) HSA 3) HRA 4) none

3) Private health insurance - Comparison of plans and providers Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements. Select the plan that most closely matches each given description. 1) Insureds create contract with an insurer who does not provide health care services 2) The higher the deductible, the lower the premium 3) Insured receive health care services from a designated group of providers 4) May not even involve an insurance company 5) No annual deduction is incurred, but a small co-payment may be required

1) Indemnity plan 2) Indemnity plan 3) Managed care plan 4) Managed care plan 5) Managed care plan

3) Private health insurance - Comparison of plans and providers Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements. Select the plan that most closely matches each given description. 1) Out-of-pocket costs generally include the plan's deductible and 20% of the plan's covered medical expenses 2) Insureds are subject to an annual deductible 3) More likely to cover preventative and routine care 4) Usually lower premiums 5) The premium represents a prepayment for one's own health care

1) Indemnity plan 2) Indemnity plan 3) Managed care plan 4) Managed care plan 5) Managed care plan

3) Private health insurance - Comparison of plans and providers Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements. Select the plan that most closely matches each given description. 1) The insurer pays the care provider or reimburses the patient for covered expenses once the deductible has been met 2) An annual deductible is incurred 3) Insureds create contract with, and make monthly payments, to the care provider 4) A HMO plan is a one example 5) Service providers must meet specific selection standards

1) Indemnity plan 2) Indemnity plan 3) Managed care plan 4) Managed care plan 5) Managed care plan

3) Private health insurance - Comparison of plans and providers Now that you've taken a closer look at the differences between these types of plans, consider the following statements. Each indicates common preferences and situations. Select the type of plan to which each statement most closely aligns. 1) I'd rather have the flexibility of either having the insurance company reimburse me or directly paying the health care provider. 2) Cost is my most important consideration. 3) I'd rather receive my health care from a group of pre-screened providers who meet specific selection standards.

1) Indemnity plan 2) Managed care plan 3) Managed care plan

3) Private health insurance - Comparison of plans and providers Now that you've taken a closer look at the differences between these types of plans, consider the following statements. Each indicates common preferences and situations. Select the type of plan to which each statement most closely aligns. 1) I'd rather receive my health care from a group of pre-screened providers who meet specific selection standards. 2) I most value the freedom of choice and am willing to pay for it. 3) I'd rather have the flexibility of either having the insurance company reimburse me or directly paying the health care provider.

1) Managed care plan 2) Indemnity plan 3) Indemnity plan

3) Private health insurance - Comparison of plans and providers Now that you've taken a closer look at the differences between these types of plans, consider the following statements. Each indicates common preferences and situations. Select the type of plan to which each statement most closely aligns. 1) I believe prevention is the best medicine. 2) My family history strongly suggests I'll suffer serious and perhaps unique illnesses as I age. 3) I'd prefer to pay a small copay rather than a larger deductible.

1) Managed care plan 2) Indemnity plan 3) Managed care plan

4. Current government health insurance plans In the United States, health care programs may be provided by the federal government, the governments of individual states, or some combination of both. It is important to know who is eligible, as well as the services provided by each of these programs. Read each of the following statements and indicate whether it applies to Medicare, Medicaid, or workers' compensation programs. 1) This program provides health insurance benefits to those who are unable to pay for their health care. 2) The prescription drug coverage provided by this program covers both brand-name and generic drugs at participating pharmacies, and is intended to help members offset the high cost of prescription drugs. 3) The benefits of this program include medical and rehabilitation expenses, disability income, and scheduled lump-sum payments for work-related death and certain injuries.

1) Medicaid 2) Medicare 3) Workers' Compensation

4) Current government health insurance plans In the United States, health care programs may be provided by the federal government, the governments of individual states, or some combination of both. It is important to know who is eligible, as well as the services provided by each of these programs. Read each of the following statements and indicate whether it applies to Medicare, Medicaid, or workers' compensation programs. 1) Part B of this federal program is voluntary and available to anyone age 65 or older can enroll—provided they are willing to pay the premiums for the coverage. 2) This program provides health insurance benefits to those who are unable to pay for their health care. 3) This program is managed and operated by each state, but is mandated by the federal government.

1) Medicare 2) Medicaid 3) Workers' compensation

5) Evaluating Your Health Care Risk A major part of determining the overall health care that's best for you is that of honestly assessing your willingness to assume responsibility for reducing your risk. You have some degree of control over two forms of risk: financial and behavioral (also known as lifestyle). For each of the following scenarios, select which type of risk reduction is illustrated. 1) Ana does not consume alcohol. 2) Ana does not text and drive. 3) Ana does not carry dental insurance.

1) Risk Avoidance 2) Loss prevention and control 3) Risk assumption

5) Evaluating Your Health Care Risk A major part of determining the overall health care that's best for you is that of honestly assessing your willingness to assume responsibility for reducing your risk. You have some degree of control over two forms of risk: financial and behavioral (also known as lifestyle). For each of the following scenarios, select which type of risk reduction is illustrated. 1) Hilary does not carry dental insurance. 2) Hilary does not go hiking in areas with large bear populations. 3) Hilary does not drink and drive.

1) Risk assumption 2) Risk avoidance 3) Loss prevention and control

5) Evaluating Your Health Care Risk A major part of determining the overall health care that's best for you is that of honestly assessing your willingness to assume responsibility for reducing your risk. You have some degree of control over two forms of risk: financial and behavioral (also known as lifestyle). For each of the following scenarios, select which type of risk reduction is illustrated. 1) Cho does not consume alcohol. 2) Cho pays lower premiums for a higher deductible. 3) Cho does not text and drive.

1) Risk avoidance 2) Risk assumption 3) Loss prevention and control

4) Current government health insurance plans 1) _____________________ is administered by each state and covers people who are hurt on the job or become sick due to work-related causes. 2) ______________________ was designed primarily to help people ____________________________, regardless of their financial position, pay their health care costs. 3) __________________________ is a state-run public assistance program that provides medical benefits to people who are unable to pay for health care. More than _____ million people across the United States are covered by the program.

1) Workers' compensation 2) - Medicare - aged 65 and above 3) - Medicaid - 65

13) Disability Income Insurance Can Replace Your Earnings if You Can't Work 1. Start with your __________________ pay. 2. Determine if you'll be eligible for Social Security disability. Remember that you will only be eligible if you expect to be disabled for at least _____________. 3. Determine if you'll be eligible for disability benefits from other government programs. Remember that if you're hurt on the job, you will probably be eligible for disability under _________________________________________________________. 4. Ask your employer about company-sponsored disability plans with benefits. Many companies provide fully paid ____________________ programs as part of their basic benefits packages. An example is sick pay. Also, although they are not exactly disability pay, see if you have paid vacation or personal days coming to you. 5. Include any proceeds you may have coming from a group disability plan in which you participate. Compare the sum of your figures from Steps 2-5 to your pay amount in Step 1 to determine the amount you would need to maintain your current income level. Note that since other sources of income unrelated to your disability _______ usually expected to continue, you ______________ including them here in your analysis of the financial changes you can expect as a result of your disability.

1) take-home 2) a year 3) your state workers' compensation insurance 4) short-term - are - are not

4) Current government health insurance plans About ____% of the United States population is covered by a government health insurance program. The three main government health care plans are: Medicare, Medicaid, and workers' compensation insurance

34%

8) Terms of payment for medical expense plans Assume that the hospital changed its payment policy to make the patient responsible for the difference between the hospital's room rate and the insurance company's responsibility ($750 per day versus $500 per day). By how much would Becky's out-of-pocket cost for her hospital room change due in hospital billing ?

Becky's costs would increase by $750.

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Alex has standard, personal medical insurance. After a recent accident, he visited the emergency room. One of the questions on the admission form asked if the accident occurred at work.

Coordination of benefits

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Cho has standard, personal medical insurance. After a recent accident, she visited the emergency room. One of the questions on the admission form asked if the accident occurred at work.

Coordination of benefits

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Manuel is covered under his medical insurance policy at work and also covered under his spouse's work plan. Manuel has some large medical bills and since both Manuel and his spouse contribute to their plans at work, Manuel is trying to figure out a way to collect benefits for some of the same charges under both plans.

Coordination of benefits

7) Surgical expenses

Covers costs for an operation deemed medically necessary; usually excludes cosmetic procedures

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Raphael has had an illness and an accident during the year. His combined out-of-pocket expense for both incidents was $1,000. The insurance company will now start to pay some of his medical expenses. What does the $1,000 represent?

Deductible

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Shen had a run of bad luck. He sprained his arm, had a staph infection, and needed surgery to remove his appendix. Out-of-pocket, Shen has paid $300 for the sprain, $500 for the infection, and $1,200 for the operation. He still has medical expenses for all three incidents. his insurance company is now paying part of the expenses related to the surgery but not the other two incidents. What does Shen's responsibility for still paying all expenses for the sprain and infection represent?

Deductible

8) Assume that the hospital changed its payment policy to make the patient responsible for the difference between the hospital's room rate and the insurance company's responsibility ($450 per day versus $300 per day). By how much would Ginny's out-of-pocket cost for her hospital room change due in hospital billing?

Ginny's costs would decrease by $300.

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Eric suffered a profound knee injury. Eric lives in a remote part of the country and depends on being in excellent physical condition to work. Eric has decided to be extra cautious when having his knee repaired. He is going to a major orthopedic hospital 2,000 miles away and having his surgery performed by one of the top 10 knee specialists in the country. He already knows that claims for the hospital services and the surgeon will exceed the reasonable and customary charges for his area. Eric is willing to pay extra for the peace of mind of knowing he received extraordinary care.

Internal limits

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Megan had routine surgery performed at Her local hospital. All charges were within the reasonable and customary costs in Her area.

Internal limits

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Poornima had routine surgery performed at her local hospital. All charges were within the reasonable and customary costs in she area.

Internal limits

4) Alex and Jake are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Alex: Alex receives health care benefits from the government. Alex doesn't suffer any disabilities, is 35 years old, and has never held a job. Which government program is providing Alex's benefits?

Medicaid

4) Hubert and Darnell are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Hubert: Hubert is unemployed. He can barely pay his rent and sometimes skips meals. He has applied to the state for help paying for his health care. If Hubert qualifies for coverage, which government program will provide his benefits?

Medicaid

4) Alex and Jake are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Jake: Jake receives health care benefits from the government. At 70 years old, Jake doesn't suffer any disabilities. He has no financial worries and is enjoying an active retirement. Which government program is providing Jake's benefits?

Medicare

4) Becky and Juanita are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Becky: Becky pays a deductible and co-insurance for her health care. She recently purchased private insurance to fill the gaps in this health coverage for which she became eligible when she turned 65. Which government program is providing Becky's benefits?

Medicare

4) Becky and Juanita are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Juanita: Juanita recently turned 65. Due to a serious accident at work, Juanita's arm had to be amputated. She received a lump-sum payment for her pain and suffering. Which government program is providing Becky's benefits?

Medicare

7) Dental services

Often a low maximum coverage, $1,000 to $2,500 per patient, for fillings, root canals, oral surgery, cleanings, orthodontics

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Bob's been hospitalized for an illness. His insurance company has started paying 90% of covered medical expenses. What does the 10% of expenses Bob will have to pay out of his pocket represent?

Participation (co-insurance)

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Kenji has been hospitalized for an illness. His insurance company has started paying 80% of covered medical expenses.

Participation (co-insurance)

8) Terms of payment for medical expense plans For each of the following scenarios, select which type of other cost or provision is illustrated. Susan had a horrible accident that required a year of treatments and rehabilitation. Fortunately, Susan's policy has a stop-loss provision that limits how much out-of-pocket expense she has to pay.

Participation (co-insurance)

7) Major medical insurance

Provides broad coverage; common lifetime limits of $500,000, $1,000,000, or no limits at all; usually includes a high deductible to protect against a catastrophic medical event

1) Custodial Care

The type of nursing home care in which an individual requires assistance for his or her normal daily activities—but does not for medical attention or supervision

1) Cancellation Clause

This clause in many health insurance contracts allows the insurer to cancel a policy at any time. The clause in many health insurance contracts that allows the insurer to cancel a policy at any time is called a cancellation clause. Some policies contain an explicit clause, while others do not. The best protection against premature cancellation is to purchase policies that specifically state that the insurer will not cancel its coverage so long as the policy's premiums are paid.

1) Own-occupation disability

This disability occurs when an insured is unable to perform the majority of the occupational duties that he or she has been trained to perform. occurs when an insured is unable to perform the majority of the occupational duties that he or she has been trained to perform. Disability policies differ in the degree of disability that must occur before benefits will be paid. Other levels of disability include any occupation and presumptive disability.

1) Affordable Care Act

This legislation requires, among other things, all Americans to have or buy health insurance beginning in 2014 or pay a penalty, and requires insurers to cover people with preexisting medical conditions without limiting or setting unrealistically high insurance rates. (ACA), known more formally as The Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, provides or requires the following: (1) all Americans are required to have or buy health insurance beginning in 2014 or pay a penalty, (2) insurers are required to cover people with preexisting medical conditions without limiting or setting unrealistically high insurance rates, (3) insurers are required to cover the children of their insureds up to the age of 26, (4) businesses with more than 50 full-time employees are required to provide health insurance coverage or pay expensive fines, (5) health care exchanges—wherein individuals and small businesses can compare insurance policy features and premiums and purchase health insurance—are required to be established.

1) Coordination of benefits provision

This provision of many health insurance policies prevents an insured from collecting more than 100% of covered charges by owning and filing claims with more than one policy. many health insurance policies is a cost-containment provision that is intended to prevent an insured from collecting more than 100% of covered charges by owning and filing claims with more than one policy. An example of the application of this policy provision involves an insurance company coordinating the amount of its claim payments with a workers' compensation commission to prevent an injured worker from collecting more than 100% of her claim.

1) Hospitalization insurance

This type of insurance usually pays a portion of a hospital's daily semiprivate room rate (including meals, nursing care, and other routine services) and the cost of related services, such as lab tests, images, and medications. usually pays a portion of a hospital's daily semiprivate room rate (including meals, nursing care, and other routine services) and the cost of related services, such as lab tests, images, and medications. Some plans pay a flat daily amount for each day the insured is in the hospital regardless of the actual charges incurred. Most policies set limits on the maximum Longtext of days of hospitalization and maximum dollar amount of ancillary services that they will pay for.

1) Health Insurance Portability & Accountability Act

Under this federal law, if you've already been covered by a health insurance plan without a break in coverage of more than 63 days and you apply for new insurance, insurers cannot turn you down, charge you higher premiums, or impose an exclusionary period due to your health status. was implemented in 1996, to protect people's ability to retain and obtain health insurance after they leave a job or retire—even if they have a serious health problem. Note that this legislation provides access to individual health insurance but does not guarantee coverage by a group policy. Under this legislation, if you've already been covered by a health insurance plan without an interruption in your coverage of more than 63 days and you apply for new insurance, insurers cannot turn you down, charge you higher premiums, or impose an exclusionary period due to your health status.

7) Dread disease insurance

Very restrictive coverage; pays a specified amount for a named disease, such as blindness, heart disease or cancer.

4) Hubert and Darnell are both entitled to government assistance for their health care costs. Based on the description of each one's situation, indicate which program will help. Darnell: Darnell is out of work on disability. Every week Darnell receives a portion of his salary while he recuperates from a broken arm. Darnell's employer pays for the insurance that provides his weekly benefit. Which government program is providing Darnell's benefits?

Workers' compensation

3) Private health insurance - Comparison of plans and providers There are several types of managed care plans, including group health maintenance organizations (group HMOs), individual practice associations HMO (IPA HMOs) preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans. Deciding which particular type of practice would best meet your needs requires knowing the major characteristics of each. Identify the particular form of private health care organization or plan described by the following three clues. - Clue #1: I can receive medical services from both in-network and out-of-network doctors and hospitals. - Clue #2: Services provided by out-of-network providers are covered by the plan but I will incur a greater cost for using them. - Clue #3: I will pay an annual deductible for this plan, and my covered costs will be reimbursed or paid to the provider, up to 80% of their total, once the annual deductible has been met. The organization or plan being described is

a PPO

3) Private health insurance - Comparison of plans and providers Patricia is able to secure health insurance because her employer has a contract with Blue Cross/Blue Shield. This is an example of ____________ insurance plan.

a group

3) Private health insurance - Comparison of plans and providers There are several types of managed care plans, including group health maintenance organizations (group HMOs), individual practice associations HMO (IPA HMOs) preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans. Deciding which particular type of practice would best meet your needs requires knowing the major characteristics of each. Identify the particular form of private health care organization or plan described by the following three clues. - Clue #1: I'll see all of the doctors and medical professionals in my plan by visiting them at a central facility. - Clue #2: To receive the covered medical services, I'll pay a monthly fee and a small copay for each visit to the doctor or prescription. - Clue #3: Many of these plans now allow me to obtain medical services from doctors or facilities located outside my plan's geographic area. If I want my plan to exhibit these characteristics, then I should purchase

a group HMO

3) Private health insurance - Comparison of plans and providers There are several types of managed care plans, including group health maintenance organizations (group HMOs), individual practice associations HMO (IPA HMOs) preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans. Deciding which particular type of practice would best meet your needs requires knowing the major characteristics of each. Identify the particular form of private health care organization or plan described by the following three clues. - Clue #1: Under this health care plan, doctors provide medical services in their own offices or in an affiliated local community hospital. - Clue #2: I will pay a $5 to $30 copayment each time I want to receive medical services or a prescription under my plan. - Clue #3: Many of these plans no longer require me to select a primary care doctor. If I want my plan to exhibit these characteristics, then I should purchase

an IPA HMO

3) Private health insurance - Comparison of plans and providers Amy purchases health insurance coverage for herself and her spouse. This is an example of ____________________ insurance plan.

an individual

3) Private health insurance - Comparison of plans and providers Zachary purchases health insurance coverage for himself. This is an example of _________________ insurance plan.

an individual

1) Preadmission certificate

ensures that a patient's insurance company has approved his or her admission to a hospital for an non-emergency scheduled stay. This requirement is intended to limit an insurer's medical expenses.

9) Terms of coverage for medical expense plans Rehabilitation coverage After a serious injury, a plan that includes rehabilitation coverage would be most helpful for a patient who _________________________________.

is disabled as a result