Exam II Review Sheet RMI 330

Exam II Review Sheet RMI 330 - Chapter 9Introduction to...

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Explain the historical development of health insurance as an employee benefit. Prior to 1930—little health insurance Blue Cross/Blue Shield—initially established to provide first-dollar hospital coverage and limited benefits Major medical introduced around 1950 Government involvement began in 1960s—Medicare and Medicaid o Increased demand led to shortages and inflation Large employers began to self-fund in the 1970s o No premium tax o No state-mandated benefit HMOs were encouraged in the 1970s, because health expenses had grown from 4.4% of GDP in 1950 to 7.3% in 1970 Was not successful in controlling costs—now, about 16% of GDP is health care costs The United States spends what percentage of its Gross Domestic Product on health care? What was this percentage in 1970? Currently 16% of GDP In 1970 7.3% of GDP What sorts of cost-containment efforts have been attempted to slow the growth of medical expenses? Be able to explain the rationale behind each of them. Self-funding benefits (50% of employees) o Cost-shifting to employees o Encouraging managed-care plans (90% of employees) o Claims review o Health education—”wellness” programs o Consumer-directed health plans o What are some of the factors in increasing health care costs? Technological advances Malpractice lawsuits Defensive medicine Design of health plans (first-dollar coverage) Third-party payment Aging population Prescription drugs What sorts of reforms have been undertaken at the state level as an attempt to control costs? Small employers (fewer than 50 employees)- National Association of Insurance Commissioners (NAIC) Model Tort reforms-limiting recovery for noneconomic loss and mandatory arbitration. Claim administration reform-standardized claim forms Single-payer reforms (Massachusetts)- What sorts of reforms have been undertaken at the federal level? What efforts have been made to reduce the number of uninsured people in the US? What is a “universal mandate”? What is a “public option”? Health Insurance Portability and Accountability Act (HIPAA) 1996 legislation Nondiscrimination rules (health status, claims experience, genetic information etc.) Guaranteed renewability Guaranteed issue for small groups ?Universal mandate - ?Public Option - What non-discrimination rules does the HIPAA legislation impose upon health plans? Act Prohibits the use of the following health related factors as a reason to exclude an employee or dependent from coverage under a group health plan or to charge the individual or dependent a higher premium. Health Status
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Exam II Review Sheet RMI 330 - Chapter 9Introduction to...

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