TN Health Insurance Latest Update Already Passed

TN Health Insurance Latest Update Already Passed Conditional Receipt -Answer If initial premium is paid at time of application, the producer with issue a continual receipt. Provides that coverage will become effective as of either the date of application or the date of completion of any required medical exam - which ever is later. Underwriting -Answer The process of selection, classification, and rating, The process of determining if someone is insurable, classifying risk, and determining rate or premium. Sources of Insurability -Answer Application, Medical exam, an attending physicians statement, the MIB, an inspection report, and the agent's report. Pre-existing condition -Answer a prior medical condition that applicant received, or should have received medical advice, diagnosis or treatment within a specified period before policy effective date Traditional Health Insurance -Answer aka indemnity or free-for-service plan -reimbursement for medical expenses -patient makes the choice of where to receive care Managed Care Plans -Answer Care plans that provide participants aka subscribers with a list of health care providers (in network) they may visit and then either cover the entire cost or collect co-pays from members, Payment Structure Comparisons (Managed Care Plans) -Answer 1) Fee-for-Service - provides separate payment to doc for med service 2) Prepaid - benefits to subscriber for monthly premiums 3) Usual, Customary, Reasonable (UCR) - benefits based on avg fee charged by all docs in area, insurers pay that & insured pay left overs. 4) Lifetime Limit - the max a policy will pay for losses during life 5) Annual Limit- max per year 6) Per cause - max per claim Heath Maintenance Organization (HMO) -Answer - aka managed health care plan - subscribers, not insureds - live in the service area - MUST use docs in-network unless emergency - emphasize preventative medicine - May have copay - No deductibles, no filing claims, no bills - PCP must refer to a specialist Preferred Provider Organization (PPO) -Answer -aka managed health care plan - prefers you to stay in network, but you can go out of network, you will just pay more - do not stress preventive care - no do not mandate pcp Point of Service (POS) -Answer insurance plan in which a patient may choose an HMO or a non-HMO provider but must pay a deductible for using a non-HMO provider