MN State Health Insurance Exam 64 Questions and Answers;(perfect guide for your final)

Information about Health Maintenance Organizations (HMOs) - -Employers with more than 25 employees must offer an HMO as an alternative to their regular health plans. -Reduce cost of healthcare through preventative care -Needs to be approved by MN DHS -Provides services rather than reimbursement -Limited service area and providers -Prepaid basis, physicians paid per head of member (capation) -INPATIENT HOSPITAL CARE IN OR OUT NETWORK Preferred Provider Organization (PPO) - -Physicians paid fees for their services and are not salaried. -Contract with employers, insurers, or third parties to provide medical care at a reduced fee. -In network but members don't have to use the network. -Don't have to select a primary care physician. -Copays and coinsurance will be higher for care out of network. Point of Service (POS) - -A combination of HMOs and PPOs. -Employees not locked into one plan or have to make a choice between two plans. -Choices can be made based on need. -Copays and coinsurance will be higher for care out of network. Cafeteria Plan - type of employee benefit plan that allows insureds to choose between different types of benefits Flexible Health Spending Accounts (FSAs) - -A form of cafeteria plan benefit funded by salary reduction and employer contributions. -Employees can deposit a certain amount of their paycheck into an account PRE TAX. -Subject to annual maximum and "use or lose" rule.-Exempt from federal income taxes, Social Security taxes, and sometimes state income taxes. Health Reimbursement Account (HRA) - -Consist of funds set aside by employers to reimburse employees for qualified medical expenses, such as deductibles or coinsurance amounts. -Employers can deduct the cost of a HRA as a business expense. -Not taxable employee benefit -Unused funds roll over -Open to companies of all sizes, employer determines eligibility and contribution limits. -Go along with a high deductible health plan for people under 30