H14: Limited Insurance Policies / MRMIP / PPACA

Frage	Antworten
Travel Accident	provides coverage for death or injury resulting from accidents occuring while a FARE-PAYING PASSENGER on a COMMON CARRIER
Specified Disease Insurance	supplemental insurance coverage for one or more specified catastrophic diseases or illnesses. (cancer, heart attack, stroke) FOOD IS NOT COVERED
Hospital Income Policy	pays a specific dollar amount on a daily, weekly or monthly basis while insured is confined to a hospital
Hospital Income Policy/Hospital Indemnity/Hospital Confinement	Hospital Income Policy/Hospital Indemnity/Hospital Confinement
Accident Only Policy	policy that provides coverage for the following when resulting from an ACCIDENT death, dismemberment, disability, hospital care, medical care
Accident	Unforseen and unintentional injury
Sickness	disease or illness
Credit Disability (Credit Health)	covers loan payments to a specific credit of the insured in the event of insureds disability Can be issued as INDIVIDUAL or GROUP policy
Credit Life	Policy that pays off outstanding loan balance to a creditor upon insured's death. Can be issued as Individual or Group policy.
Blanket Policy	a form of group health insurance where individuals are automatically covered by their affiliation with the group Usually the insured is not even reported to the insurer until a claim is made.
Major Risk Medical Insurance Program (MRMIP)	a STATE program that provides health insurance for Californians unable to obtain coverage in the individual health insurance market because of pre-existing conditions.
Managed Risk Medical Insurance Board duties include:	determind applicant eligibility, program coverage, contribution amounts, contracting with health plans, issuing rules and regulations
MRMIP Eligibility Requirements	Must be a resident of California, must have pre-existing condition, must NOT be eligible for medicare Part A or Part B
MRMIP	subscribers can enroll dependents on same application as long as dependent meets all the same eligibility requirements except that dependent NOT required to have pre-existing condition.
At Time, MRMIP may have a waiting list due to limited funding. When funding is limited, individuals who qualify for MRMIP will be placed on a waiting list until enrollment slots become available.	At Time, MRMIP may have a waiting list due to limited funding. When funding is limited, individuals who qualify for MRMIP will be placed on a waiting list until enrollment slots become available.
Waiting List	Placement on waiting list based on date a completed MRMIP app is received.
Tobacco Tax Fund helps fun MRMIP	Tobacco Tax Fund helps fun MRMIP
PPACA Overview	reforms certain aspects of private health insurance industry and public health insurance programs, increases coverage for pre-existing conditons and expands access to insurance to over 30 million Americans
Health Benefit Exchange	entitiy intended to create a more organized and competitive market by offering a choice of plans made available by commercial insurers, establishing common rules regarding offering and pricing, and providing information to help consumers better understand the options available to them.
CAs Health Benefit Exchange CANNOT deny someone with pre-existing condition	CAs Health Benefit Exchange CANNOT deny someone with pre-existing condition
CAs Health Benefit Exchange open to individuals and small employers (<100 employees)	CAs Health Benefit Exchange open to individuals and small employers (<100 employees)
Coverage for Adult Children up to 26	Children can be covered under parents group health plan up to age 26 coverage CANNOT be restricted because of: financial dependency, residency, student status, employment status
Children under 19 cannot be declined health coverage due to pre-existing conditions (they are guaranteed issue of a policy) effective 9/23/2010, applies to new and grandfathered plans	Children under 19 cannot be declined health coverage due to pre-existing conditions (they are guaranteed issue of a policy) effective 9/23/2010, applies to new and grandfathered plans
Medical Loss Ratio	a metric used in managed health care and health insurance to measure medical costs as a percentage of premium revenues.
MLR= Claims/Total Premiums	MLR= Claims/Total Premiums
MLR Requirements	Large Group= 85% Small Group=80% Rebates required when MLR requirements not met
Access for Infants & Mothers (AIM)	state program that provides low cost health insurance coverage to pregnant women who do not have insurance to cover their pregnancy
Qualification for (AIM-Access for Infants & Mothers)	must be pregnany, but not >30 weeks, CA resident, must not be a recipient of Medical/Medicare, high copay of more than $500, must meet household income guidelines.
Healthy Families	state programs which provides low cost insurance that provides health, dental, and vision coverage to qualifying children Monthly premiums due, co-pay, $250 max for co-pays,
Qualifications	under 19 who live in Ca, not covered under employer-sponsored in 3 months, not be eligible/enrolled in no-cost medical, must meet citizenship or immigration rules, must meet household income guidelines How to apply? health E app
MRMIP= State Funded PCIP: Federally Funded	MRMIP= State Funded PCIP: Federally Funded

Nächster

H14: Limited Insurance Policies / MRMIP / PPACA

Beschreibung

Zusammenfassung der Ressource

ähnlicher Inhalt

	Erstellt von Det Ferraris vor mehr als 11 Jahre