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Health Medical Plans (L&A/H)

Medical Plan Concepts

Fee-for-Service vs. Prepaid
Specified Coverage vs. Comprehensive Care
Benefit Schedule vs. Usual
Any Provider vs. Limited Choice
Insureds vs. Subscribers/Participants
Dependent Coverage
Deductibles
Coinsurance
Stop-Loss Provision

Types of Providers and Plans

Major Medical Insurance
Major Medical Insurance—Out of Pocket
Major Medical Insurance—Covered Expenses
Major Medical Insurance—Exclusions
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Open Panel vs. Closed Panel

Cost Containment

Cost Containment
Managed Care
Preventive Care
Hospital Outpatient Benefits
Maternity Stay Minimum Limits
Utilization Management

Utah Requirements

Newborn Child Coverage
Dependent Child Age Limit
Court Ordered Dependency Coverage
Handicapped Children Extension
Adoptions
Alcohol and Drug Dependency
Uniform Health Benefit Card

HIPAA

What is HIPAA?
HIPAA Terms
Privacy
Portability
Portability — Losing Group Coverage
Portability — Changing Jobs

HSA and HRA

Health Savings Account (HSA)
Health Reimbursement Arrangement (HRA)

Affordable Care Act

What is the ACA?
Essential Health Benefits
Preventive Care
Metal Categories
Young Adult Coverage
Pre-Existing Conditions

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CONTACT US

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9:00am to 7:00pm, Mountain Time

Monday thru Friday

Office Phone

(801) 518-1956

Text Us (anytime)

(801) 518-5016

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marlene@mountainCE.com

rjmauer@mountainCE.com

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