Individual Health Insurance Coverages (Unit 4 Exam)

• -rising health-care expenditures
• -large number of uninsured in the population
• -uneven quality of medical care
• -considerable waste and inefficiency

a plan that pays a high percentage of covered expenses incurred by an insured who has a catastrophic illness or injury

• -high lifetime limits
• -broad range of benefits
• -deductible
• -coinsurance
• -out-of-pocket limit
• -exclusions
• -internal limits

surgeons and other physicians are commonly reimbursed by this; it varies by insurer

an aggregate deductible that has to be satisfied only once during the calendar year

only one deductible has to be satisfied if two or more family members are injured in a common accident, such as an auto accident

requires the insured to pay a certain percentage of elible expenses in excess of the deductible

a flat amount that the insured must pay for certain benefits, such as $25 for a visit to a primary care physician, or a $10 copaymeny fee for a generic drug

100% of the covered medical expenses in excess of the deductible are paid after the insured incurs a certain annual amount of out-of-pocket expenses

major medical policies have this on the amounts paid for certain services

physicians, hospitals, and other health-care providers who are part of a plan network and agree to provide medical services to plan members at discounted fees

a tax-exempt or custodial account established exclusively for the purpose of paying qualified medical expenses of the account beneficiary who is covered under a high-deductible health insurance plan

pays a daily or monthly benefit for medical or custodial care received in a nursing facility, in a hospital, or at home

a waiting period during which time benefits are not paid

eating, bathing, dressing, transferring from a bed to a chair, using the toilet, and maintaining continence

determines whether the insured is chronically ill and eligible for benefits

provides income payments when the insured is unable to work because of sickness or injury

the complete inability of the insured to perform each and every duty of his or her own occupation

the inability of the insured to perform one or more important duties of his or her occupation

a pro rated disability benefit is paid to an insured whose earned income is reduced because of an accident or sickness

if the insured is totally disabled for 90 days, future premiums will be waived as long as the insured remains disabled

the insurer has the right to terminate a policy on any anniversary datee, or in some cases, on a premium date

the insurer guarantees to renew the policy to some stated age. However, the insurer has the right to increase premium rates for the underwriting class in which the insured is placed

This cannot be canceled. The insurer guarantees renewal of the policy to some stated age, and the premiums are guaranteed and cannot be increased during that period

a physical or mental condition for which the insured received treatment or that existed during some specified time period prior to the effective date of the policy

a 31-day period after the premium due date to pay an overdue premium

permits the insured to reinstate a lapsed policy

after the policy has been in force for two years, the insurer cannot void the policy or deny a claim on the basis of misstatements in the application, except for fradulent misstatements

covers only certain diseases or accidents, pays limited benefits, or places serious restrictions on the right to receive the benefits

one example of a limited policy. It pays a fixed daily or monthly cash benefit if you admitted to a hospital

another example of a limited policy. This policy covers only certain diseases listed in the policy, such as cancer, multiple sclerosis, or muscular dystrophy

a list of these policies is endless, but includes accident insurance offered by sponsors of credit cards, travel accident policies to cover you while on vacation, and airline accident policies sold over the counter or from vending machines in airports

• -the policyowner attains a certain age
• -the policyowner is no longer employed
• -the insurer decides to nonrenew all policies with the same form number as the policyowner's policy

• -insure for the catastrophic loss
• -consider group insurance first
• -purchase a policy that has a preferred provider network
• -don't ignore disability-income insurance
• -avoid limited policies
• -use deductibles and elimination periods to reduce premiums

• -major medical insurance
• -health savings accounts
• -long-term care insurance
• -disability-income insurance

• -optionally renewable
• -nonrenewable for stated reasons only
• -guaranteed renewable
• -noncancellable