| A | B |
|---|
| Contributory | At least 75% of all eligible employees must participate and both the employer and the employee contribute to the premium payment |
| Non-contributory | 100% of the eligible employees must be included, and the employees do not pay any part of the premium |
| Association-Sponsored Group | Eligible groups include but are not limited to trade associations, professional associations, college alumni associations, veteran associations, customers of large retail chains, and savings account depositors |
| Requirements of Association-Sponsored Groups | Have at least 100 members, Be organized for a reason other than buying group insurance, Have been active for at least two years, Have a constitution, by-laws, and must meet at least annually |
| Master Contract | The actual policy |
| Certificates of insurance | Proof of coverage under a group health insurance policy |
| Individual Health Insurance | “guaranteed renewable” so there is underwriting to determine insurability |
| Group Health Insurance | Everyone is insured underwriting is less restrictive |
| Conversion Privilege | Allows individuals within a group policy to convert their group certificate to an individual Medical Expense policy with the same insurer, if and when they leave their employment. This typically must take place within 30 or 31 days from employment ending |
| Managed Care | Any medical expense plan that attempts to contain costs by controlling the behavior of its participants. |
| Characteristics of managed care plans | Controlled access of providers, Comprehensive case management, Preventive care, Risk sharing, High quality care |
| Endodontics | Treatment of the dental pulp of the natural teeth. An example is root canal treatment. |
| Periodontics | Treatment of the surrounding and supporting tissue of the teeth. An example is the treatment of gum disease. |
| Prosthodontics | The replacement of missing teeth with artificial devices. Examples include bridgework or dentures |
| Orthodontics | The treatment of natural teeth to prevent and/or correct dental anomalies. Examples: braces and appliances |
| COBRA (Stands for) | The Consolidated Omnibus Budget Reconciliation Act |
| COBRA | Requires any employer with 20 or more employees to extend Group Health coverage to terminated employees and their families for up to a period of 36 months after a qualifying event |
| ASO (Administrator Services Only) | A company can contract with an existing licensed insurance company for administrative services. |
| TPA (Third Party Administrator) | A company can contract with another company, not an insurance company, for administrative services. |
| Section 125 | The Internal Revenue Code permitting implementation of an FSA |
| Consumer Driven Health Plan (CDHP) | Allows employees to take more responsibility for their health care, pair a high-deductible catastrophic plan with a Health Savings Account (HSA) or a Health Reimbursement Account (HRA) |
| Medical Savings Account | Employer funded medical account linked to a high deductible medical indemnity plan. Usually, the employer purchases a high deductible medical plan and in return experiences a premium savings over the more traditional medical plan. A portion of the premium saved as a result of the high deductible plan is returned to savings account established for each employee |
| Health Savings Account | A tax sheltered trust account that is owned by an insured employee for the purpose of paying qualified medical expenses for the participating employee and dependents. Earns interest, allows tax-deductible contributions, allows participants to withdraw funds for non-medical purposes and is portable |
| Health Reimbursement Arrangement | An employer funded tax sheltered account to reimburse allowable medical expenses to participants. |
| Blanket Health Plans | Issued to cover a group who may be exposed to the same risks, but the composition of the group constantly changes. Examples: Airline, or a bus company to cover its passengers or to a school to cover its students |
| Franchise Health Plans | “Wholesale plans”, provide health insurance coverage to members of an association or professional society. |
