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Products and Terms.

Health products come in a wide variety of forms and address basic health needs, ranging from medical care to specialized forms of illness and accident coverage. Health products include:

Indemnity Health Plans: These may be offered on an individual or group basis. Indemnity plans allow members to choose their own doctor or hospital. The carrier then pays a fixed portion of total charges. Indemnity plans are often known as "fee-for-service" plans.

High-Deductible Health Plans: These may feature low premiums and an integrated deductible for both medical and pharmacy costs. Some plans combine a health plan with a Health Savings Account.

Health Savings Accounts: Participants may contribute pretax money to be used for qualified medical expenses. HSAs, which are portable, must be linked to a high-deductible health insurance policy.

Health Reimbursement Arrangements: HRAs are available to high-deductible health plan owners who are not qualified for health savings accounts.

Dental Plans: Traditional dental plans may help cover preventive, basic and major services.

Dental Preferred Provider Organizations: These offer discounts to members who use in-network dental providers.

Vision Plans: Vision care plans may cover regular eye exams, treatment for conditions and assistance with corrective lenses.

Pharmacy: Plans may cover part or all of prescription drug costs.

Flexible Spending Account (FSA): A program where employees may contribute pretax money to be used for medical expenses, including copays, coinsurance, and any non-covered services or over the counter medication.

Medicare Advantage: This provides Medicare-eligible retirees the benefits of Medicare, plus additional features and benefits such as wellness program and case management services. Retirees who select Medicare Advantage agree to use in-network doctors and hospitals or face much higher out-of pocket costs.

Common Health Insurance Terms Include:

Coinsurance: For health insurance, it is a percentage of each claim above the deductible paid by the policyholder. For a 20% health insurance coinsurance clause, the policyholder pays for the deductible plus 20% of covered losses. After paying 80% of losses up to a specified ceiling, the insurer starts paying 100% of losses.

Copayment: A predetermined, flat fee an individual pays for health care services, in addition to what insurance covers. For example, some HMOs require a $20 copayment for each office visit, regardless of the type or level of services provided during the visit. Copayments are not usually specified by percentages.

Disease Management: A system of coordinated health care interventions and communications for patients with certain medical conditions.

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Title Annotation:CHAPTER 4:HEALTH
Publication:Best's Review
Date:Nov 1, 2017
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