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CEBS GBA 1: Assignment 3 Exam (based on the 2013 learning guide for GBA 1)
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CEBS GBA 1: Assignment 3 Exam (based on the 2013 learning guide for GBA 1)
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CEBS GBA 1: Assignment 3 Exam(based on the 2013 learning guide
for GBA 1)
prepaid service plans - -this type of plan provided a set allowance (level of
benefit) for hospital/medical services and paid them directly to the provider
ex: blue cross blue shield
-indemnity plans - -plans that reimbursed or indemnified a set dollar
amount to the subscriber
-first dollar coverage - -plan pays benefits from the minute an expense is
incurred. the subscriber pays no expense. this model was used in early
hospital and medical plans when costs and utilization patterns were lower
this type of coverage is not used often today
it has been replaced with plans that use deductibles, coinsurance provisions
or other cost containment measures. managed care has also replaced this
type of coverage
-list the types of hospitalization benefits covered in health plans - -1.
inpatient room and board
2 emergency care
3 intensive and specialty care
4 maternity and newborn care
5 xray, diagnostic testing and laboratory expenses in a hospital
6 skilled nursing facility care
7 radiation and chemo
8 inpatient mental and nervous care
9 inpatient drup and alcohol abuse care
10 physical, inhalation andcardiac therapy
11 home health care
12 hospice
13 respite care
-list the types of medical benefits covered in health plans - -1. surgeons
2 anesthesiologists
3 nurse and other surgical assistants
4 service fees assoc with inpatient medical care
5 second surgical opinions
, 6 xray and diagnostic and lab expenses
7 skilled nursing care
8 obs and pediatriacians assoc with prenatal delivery and newborn care
9 inpatient ICU
10 allergy testing
11 transplant services
12 administration of radiation and chemotherapy
13 inpatient physical therapy
14 immunizations for children
-what were the early cost sharing techniques used in major medical
coverage? - -deductibles and coinsurance
-deductibles - -the amount of covered medical expense that a subscriber
must pay before the plan pays benefits
-coinsurance - -amount that is usually a percentage of total charges for
which the plan participant is responsible once the deductible is exceeded
-what are the good parts to using deductibles and coinsurance as cost
saving devices? - -1. may lead to a reduction in the use of health services
and thus a reduction in costs
2 may reduce premiums because the health plan pays less. saving are
passed to the employer and or employee. but some of the cost is shifted
from employer to employee
3 create equity because the amount insured persons pay is related to their
use of health services
-what are the bad parts to using deductibles and coinsurance as cost saving
devices? - -1. may not reduce utilization of health services because
physicians not consumers make decisions
2 may discourage preventive care
3 may present a financial barrier to necessary care
-how does major medical insurance work? - -this plan was originally often
combined with first dollar prepaid service plans.
when the benefit allowances for hospital or medical services were exceeded
by a participant then the plan would start paying a second level of
reimbursement thru the major medical component
coinsurance and deductibles would apply
this policy was written as "all-except" coverage rather than as a named peril
coverage
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