Exam 4

These flashcards cover essential vocabulary and concepts related to health insurance, legal liability, and automobile policies.

Health Insurance

Coverage that pays for medical expenses for individuals and families.

Three-Party System in Healthcare

Involves providers, consumers, and third-party insurers.

Provider/Seller

Includes doctors, hospitals, and medical companies.

Consumer/Buyer

Patients, insured employees, or the government.

Fee-for-Service (FFS)

Payment structure where services are billed separately.

Over-utilization of healthcare services

Increased use of healthcare due to lower user prices.

National Health Expenditures (2022)

Approx. $4.5 trillion or 16.6% of GDP.

Per Capita Healthcare Cost

Average cost per person for healthcare, about $12,555 in the U.S.

Behavioral Factors

Lifestyle diseases contributing to healthcare costs.

Defensive Medicine

Practices that increase healthcare costs due to fear of lawsuits.

Affordable Care Act (ACA)

Law that includes provisions like guaranteed issue and community rating.

Guaranteed Issue

Insurers cannot deny coverage for pre-existing conditions.

Community Rating

Insurance premiums are based on a broad range of variables.

Minimum Health Standards

Regulations ensuring essential benefits in health coverage.

Individual Mandate

Requirement to purchase health insurance or face penalties (now repealed).

Health Insurance Exchanges

Platforms for purchasing healthcare insurance.

Copayments

Fixed fees paid for specific healthcare services.

Deductibles

Amount paid by the insured before insurance coverage applies.

Coinsurance

Percentage of costs paid by the insured after meeting the deductible.

Out-of-Pocket Maximum

Maximum amount one must pay within a year.

Individual Medical Expense Insurance

Coverage for individuals unable to get group insurance.

Group Medical Expense Insurance

Insurance through employers covering various medical costs.

Managed Care Plans

Insurance designed to provide services cost-effectively.

Health Maintenance Organization (HMO)

Prepaid healthcare system with limited provider choices.

Preferred Provider Organizations (PPO)

Networks offering discounted services with flexibility.

Point of Service (POS)

Combination of HMO and PPO with in-network benefits.

Consumer Directed Health Plan (CDHP)

High-deductible plan paired with a Health Savings Account.

Health Savings Account (HSA)

Tax-exempt account for medical expenses with high-deductible plans.

Flexible Spending Accounts (FSA)

Pre-tax dollars for unreimbursed medical expenses.

Legal Wrong

Violation of a person's legal rights or duty.

Tort

A legal wrong allowing monetary damages as a remedy.

Plaintiff

The injured party in a tort case.

Tortfeasor

The alleged wrongdoer in a tort case.

Intentional Tort

An intentional act resulting in harm.

Strict Liability

Liability without regard to negligence or fault.

Negligence

Failure to exercise reasonable care resulting in harm.

Standard of Care

The level of care a reasonably prudent person would provide.

Compensatory Damages

Damages that compensate for losses incurred.

Punitive Damages

Damages intended to punish and deter wrongful acts.

Contributory Negligence

If the injured party is negligent, they cannot recover damages.

Comparative Negligence

Burden is shared based on fault.

Last Clear Chance Rule

Injured party can recover if the defendant missed an opportunity to prevent the accident.

Assumption of Risk

Recovery of damages is denied if the party recognized inherent risks.

Imputed Negligence

One person's negligence attributed to another under certain conditions.

Res Ipsa Loquitur

"The thing speaks for itself." Injury occurrence implies negligence under specific circumstances.

Attractive Nuisance

A condition attracting children leading to potential liability.

Respondeat Superior

Employers may be liable for employees' negligent acts.

Parental Liability

Parents may be liable for their children's actions.

Personal Auto Policy (PAP)

Insurance policy covering personal vehicles.

Liability Coverage

Covers legal claims due to vehicle ownership or operation.

Medical Payments Coverage

Covers medical costs from auto accidents regardless of fault.

Uninsured Motorist Coverage (UM)

Coverage for injuries from uninsured or hit-and-run drivers.

Underinsured Motorist Coverage (UIM)

Coverage when the negligent driver’s insurance is insufficient.

Collision Coverage

Covers accidents regardless of fault.

Comprehensive Coverage

Covers incidents like theft or natural disasters.

Total Loss Payment

Payment based on actual cash value in the event of a total loss.

Partial Loss Coverage

Covers repair and replacement costs for partial losses.

Deductibles

Amount the insured is responsible for out-of-pocket before coverage kicks in.

Gap Insurance

Covers the difference between insurance payout and owed loan amount.

No-Fault Auto Insurance

Each party collects from their insurer regardless of fault.

Personal Auto Insurance Rating Variables

Factors influencing auto insurance rates.

Cost Sharing

The sharing of healthcare costs between insurers and insured individuals.

Claim Payments

Insurers required to pay a minimum percentage of premiums in claims.

Employer Mandate

Requirement for employers to provide insurance for employees.

Subsidies

Financial assistance for low-income families for health insurance.

Rights of Policyholders

Protections and standards established for individuals with health insurance.

Healthcare Cost Transparency

The clarity of healthcare prices and quality for consumers.

High Administrative Costs

The expenses incurred in managing healthcare systems.

Cost-Shifting

Transferring costs from one payer to another, often seen in Medicaid and Medicare.

Libel

Defamation by written or published words.

Slander

Defamation by spoken words.

Assault

An act causing apprehension of harmful or offensive contact.

Battery

The actual physical act of harmful contact.

Negligence Elements

Factors necessary to prove negligence: legal duty, breach, damage, proximate cause.

Joint Business Venture Liability

Shared liability among participants in a joint business.

Dram Shop Law

Holds establishments liable for serving visibly intoxicated patrons.

Vicarious Liability Law

Legal principle of holding employers accountable for employee actions.