| Premiums | The monthly or annual cost of a health care plan |
| Patient Protection and Affordable Care Act (ACA) | The law passed by Congress in 2010 to provide affordable health insurance for all US citizens and reduce the growth in health care spending |
| Essential Health Benefits | A list of ten categories of benefits that all health care plans sold on the health insurance exchanges must providee |
| Health insurance exchange (HIX) | Stat-by-state mechanisms established by the ACA through which consumers can purchase a health care plan |
| Health care plan | Generic name for any program that pays or provides reimbursement for health care expenditures |
| Group health plan | Sold collectively to an entire group of people rather than to individuals, such as the group health care policies offered by employers |
| Health insurance | Provides protection against direct medical expenses resulting from illness and injury based on the concept of payment after an expense occurs |
| Deductibles | Clauses in health care plans that require the participant to pay an additional portion of health expenses annually before receiving reimbursement |
| Health maintenance organizations (HMOs) | Health insurance plans that provide a broad range of health care services for a set monthly fee on a prepaid basis |
| Preferred provider organization (PPO) | Group of health care providers (doctors, hospitals, and other health care providers) who contract with a health insurance company to provide services at a discount |
| COBRA rights | The Consolidated Omnibus Budget Reconciliation Act of 1985 allows a former employee to remain a member of a group health plan for as long as 18 months if the employee worked for an employer with more than 20 workers |
| Medicare | The federal government’s health care program for the elderly |
| Medicaid | A government health care program for low-income people funded jointly by the federal and state governments |
| Health savings account (HSA) | Tax-deductible savings account into which individuals or employers can deposit tax-sheltered funds to pay medical bills |
| Certificate of insurance | Document or booklet that outlines group health insurance benefits |
| Co-payment | A variation of a deductible that requires you to pay a specific dollar amount each time you use your benefits for a specific covered expense item |
| Coinsurance clause | A clause in a health care plan that requires the participant to pay a proportion of any loss suffered |
| Long-term care insurance | Provides reimbursement for costs associated with custodial care in a nursing facility Or at home |
| Activities of daily living (ADLs) | Insurance companies use the inability to perform a certain number of such activities as a criterion for deciding when the insured becomes eligible for long-term care benefits |
| Custodial care | Suitable for people who do not need skilled nursing care but who nevertheless require supervision (for example, help with eating or personal hygiene) |
| Benefit period | The maximum period of time for which benefits will be paid under a disability income or other insurance |
| Waiting period (elimination period) | The time period between the onset of a disability and the date that disability benefits begin |
| Disability income insurance | Insurance that covers a portion of the income lost when you cannot work because of illness or injury |
| Social Security Disability Income Insurance | Under this government program, eligible workers can received some income if their disabilities are total, meaning that they cannot work at any job |
| Any-occupation policy | Provides full benefits only if the insured cannot perform any occupation |
| Residual clause | Feature of own-occupation policies that allows for some reduced level of disability income benefits when a partial-rather than full-disability strikes |
| Social Security rider | Provides an extra dollar amount of protection if a person fails to qualify for Social Security disability benefits (70 percent of all applicants are rejected) |
| Advance medical directives | Treatment preferences and the designation of a surrogate decision maker in the even that a person should become unable to make decisions on her or his own behalf |
| Health care proxy | A legal document in which individuals designate another person to make health care decisions on their behalf if they are rendered incapable of making their wishes known |
| Living will | Allows you to document in advance your specific wishes concerning medical treatments in an emergency or during end-of-life health care |
| Will is concerned that his monthly disability income benefit would be eroded by inflation in case of a long-term disability. Which policy provision would guard against this problem? | Cost-of-living adjustments |
| Your health insurance requires that you pay $50 each time you visit the doctor’s office and $15 for each prescription drug. This is an example of | A copayment |
| One cannot rely on worker’s compensation to cover your health care needs because it | Covers only job-related injuries and illnesses |
| Which of the following best describes a preexisting condition? | A previously diagnosed medical condition |
| A legal document in which individuals designate another person to make health care decisions on their behalf if they are incapable of making their wishes known is called a | health care proxy |
| ___is a long-term care provision that is especially important for a relatively young person purchasing this type of insurance. | Inflation protection |
| Which of the following government programs is jointly funded by federal and state governments? | Medicaid |
| Traditional health insurance provides protection against direct medical expenses and, thus, does not cover | lost income when you cannot work due to illness or injury |
| Eligibility for which of the following is based on household income and net worth? | Medicaid |
| To make it possible for consumers to comply with the individual mandate to buy health insurance the Affordable Care Act established____ run by their states or the federal government | health insurance exchanges |
| In what way(s) can health care costs potentially provide an income tax benefit? | All of these(itemizing deductions for health care expenditures, flexible spending arrangement through an employer, and writing off a portion of premium by self-employed people) |
| Your waiting period on disability income insurance can be____ if you have some savings set aside as an emergency fund. | lengthened |
| Medicare Part B covers all of the following except | hospitilization |
| Lyle’s health care plan will pay 75 percent of all covered expenses over the first $500 per year. This policy contains | coinsurance and deductible |
| The disability income insurance feature that provides a reduced level of benefit when you suffer a partial disability is called a | residual clause |
| A longer waiting period on a disability income policy will | reduce the disability income insurance premium |
| The period of time each year when you can make changes in your selection of health care plans available from your employer is called a(n) | open-enrollment period |
| Which of the following can provide increased disability income from your disability income policy whenever you do not qualify for Social Security disability benefits? | social security rider |
| Which of the following is NOT true of Medicare Part B? | Does not cover outpatient care |
| The cost of a health maintenance organization is generally a(n) | monthly fee, a deductible, and copayments |
| Long-term custodial care is covered by | Medicaid |
| Persons who have a high-deductible health plan can make tax-sheltered deposits into an investment account called a___ from which they can pay medical expenses | health savings account |
| A____ does not take effect until a specified event occurs, usually physical or mental incapacitation | durable power of attorney |
| _____provide(s) preventative care as well as other types of care for a set monthly fee which is considered to be advance payment for the care received | Health maintenance organization (HMO) |
| Traditional health insurance plans typically have___and____requirements that result in out-of-pocket costs for the insured | deductibles; coinsurance |
| __provide(s) preventative care as well as other types of care for a set monthly fee which is considered to be advance payment for the care received. | health maintenance organization (HMO) |
| Drawbacks of an HMO include | limited choice of physicians |
| Most companies will NOT write disability income policies for more than___percent of one’s after-tax earnings. | 60 to 80 |
| Lance, a volunteer baseball coach, was hit by a hard line drive. As a result of the injury, Lance was taken to the emergency room for treatment and admitted to the hospital. Lance’s covered expenses totaled $4,000. How much of the $4,000 will Lance have to pay if these are his first medical expenses of the year and he has the following health insurance coverage?$500 deductible per year80/20 coinsurance$1,000 per year out-of-pocket coinsurance cap | $1,200 |
| Medicare Part A | is a hospitalization program for persons over 65 and requires no premiums |
| Your waiting period on disability income insurance can be__ if you have some savings set aside as an emergency fund | lengthened |
| You can help yourself afford a longer benefit period under a long-term care insurance plan by selecting a longer | waiting period |
| If a long-term care policy is purchased prior to age___,the buyer faces a significant risk because inflation may render the daily benefit woefully inadequate when care is ultimately needed | 60 |
| Health care plans for Medicare eligible people that are purchased through a private company and provide both Medicare Parts A and B coverage are called. | Medicare Advantage Plans |
| In a dual-income household where both employers provide a health care plan, it is important to choose to be covered under the plan that provides__and is___. | more protection; less expensive |
| Reimbursement for costs associated with intermediate and custodial care in a nursing facility or at home is provided by | long-term care insurance |
| A___ does not take effect until a specified event occurs, usually physical or mental incapacitation | durable power of attorney |
| Under the Affordable Care Act, all health care plans must include | ten specified essential health benefits |
| A person who wants to continue health insurance coverage through your COBRA rights must | pay the full premiums plus a 2 percent administrative fee |
| An alternative name for traditional health insurance is a(n)? | fee-for-service plan |
| A group of physicians and hospitals who have banded together to offer a health insurance contract in areas where there is no available HMO is called a | preferred-provider network |
| To qualify as a high-deductible health care plan, the deductible must be at least | $1000 |
| Under the Affordable Care Act, your level of income used to calculate the maximum tax penalty if you have a health care plan is your | modified adjusted gross income |
| … | … |
