Principles of Risk Management and Insurance - Healthcare Reform

These flashcards help review key concepts related to healthcare reform, insurance provisions, and individual health coverage as discussed in the Principles of Risk Management and Insurance lecture.

Affordable Care Act (ACA)

A U.S. law aimed at increasing health insurance quality and affordability, reducing uninsured rates, and containing healthcare costs.

Managed Care

A system of health care delivery that integrates the financing and delivery of services with an emphasis on cost control.

Health Savings Account (HSA)

A tax-exempt account used to pay for qualified medical expenses, requiring the holder to be enrolled in a high-deductible health plan.

Long-Term Care Insurance

Insurance that provides coverage for medical and custodial care received in nursing facilities, hospitals, or at home, typically for individuals over age 65.

Disability Income Insurance

Insurance that provides income payments to individuals who are unable to work due to sickness or injury.

Individual Mandate

A provision in the ACA requiring most citizens and legal residents to have qualifying health insurance or pay a penalty.

Essential Health Benefits

A set of health care service categories that must be covered by certain plans under the ACA.

Preexisting Condition

A medical condition that existed before health insurance coverage began, which cannot be excluded from coverage under the ACA.

Coinsurance

A percentage of a medical bill that the insured must pay after the deductible has been met, designed to share costs and prevent overutilization.

Out-of-Pocket Limit

The maximum amount an insured must pay for covered healthcare services in a plan year, after which the insurer pays 100% of covered expenses.

Rehabilitation Provision

A clause in disability insurance policies allowing support for rehabilitation to help the insured return to work.

Lifetime Limit

A cap on the total benefits an insurance company will pay to a policyholder during their lifetime; prohibited by the ACA.

Noncancellable Policy

A type of insurance policy that cannot be canceled or changed by the insurer as long as premiums are paid on time.

Grace Period

A specified time following the premium due date during which a policyholder can make a payment without losing coverage.

Cost-sharing Reductions

Financial assistance provided under the ACA to lower the amount that eligible individuals must pay out-of-pocket for deductibles and copayments.

Catastrophic Plan

A type of health insurance plan that covers essential health benefits but has lower premiums and higher deductibles, aimed at young adults.