Chapter 4 And 5 Test

Front 1

COBRA

Back 1

(Consolidated Omnibus Budget Reconciliation Act)

"Bridge insurance."

Type of insurance offered to unemployed individuals after getting fired, laid off or quit.

Front 2

Medically Necessary

Back 2

Medicare and Medicaid determines if a procedure needs to be done (if it is necessary)

Front 3

FSA

Back 3

(Flexible Spending Account)

Tax advantage savings account set up by an employer to allow tax-free savings for qualified medical or dependent care expenses.

ex. Medication, Childcare

Front 4

Fee-for-Service

Back 4

(Also known as Indemnity Plan)

Health insurance individuals (usually wealthy) can purchase the provides comprehensive major medical benefits and allows the individual to go to any doctor or hospital.

Front 5

Deductible

Back 5

Amount of money you must pay before the insurance begins to cover services.

Front 6

Copayment

Back 6

a payment made by a beneficiary (health services) in addition to that made by an insurance.

Front 7

Non-Par Provider

Back 7

Medical practice or hospital that does not accept a certain type of insurance.

Front 8

Par-Provider

Back 8

Medical practice or hospital that does accept a certain type of insurance.

Front 9

UCR

Back 9

(Usually Customary and Reasonable)

How insurance deems reimbursement typically by geographical location.

Front 10

Worker's Compensation

Back 10

A type of insurance give by an employer after an employee suffered an injury or disability while on the job.

Front 11

Health Insurance

Back 11

Narrows down to illness and injury.

Front 12

Medicare

Back 12

Federal insurance for the eldery

Front 13

Medicaid

Back 13

Federal insurance for the low-income class.

Front 14

Managed Care Organization

Back 14

(MCO)

-Evolved in the late 20th century

-Someone in charge of your health; Can literally mandate if you live or die.

Front 15

What are the factors that drive health care issues?

Back 15

-Regulating managed care

-Emergency services

-Access for uninsured Americans

Front 16

How does everyone usually obtain health insurance?

Back 16

Insured by group policies.

Front 17

What group of people are typically uninsured?

Back 17

-Self employed

-Part-time employees

-Low-wage earners

Front 18

HIPAA

Back 18

(Health Insurance Portability and Accountability Act)

Confidentiality; To eliminate preexisting judgement

Front 19

Indemnity Plan

Back 19

Alternative name for fee-of-service

Front 20

Premium

Back 20

A monthly dollar amount to offset the cost of your policy

Front 21

How are insurance payments based on?

Back 21

UCR

Front 22

What is an out-of-pocket maximum?

Back 22

Amount you'll pay for covered services in a benefit period.

Front 23

What is the universal claim form?

Back 23

CMS-1500

Front 24

How are you referred to under managed care?

Back 24

Enrollee

Front 25

What is a group policy?

Back 25

When a business entity covers it's employees.

Front 26

Medical Savings Account

Back 26

(MSA)

Special tax shelter set up for the purpose of paying medical bills for individuals who choose a low cost, high deducible health care policy.

Front 27

What service will most third party payers not pay for?

Back 27

Most third party payers will not pay for non-medically necessary procedures.

ex.

Plastic Surgery

Front 28

MCO

Back 28

Managed Care Organization

-Someone in charge of your health.

Front 29

PPO

Back 29

Preferred Provider Organization

-No referrals, out of network, no deductible and no co/ins

Front 30

POS/EPO

Back 30

Point of Service

Exclusive Provider Organization

-No referrals, in-network, no-deductible and no co/ins

Front 31

HMO

Back 31

Health Maintenance Organization

PCP (gatekeeper), referrals, deductible and has co/ins.

Front 32

What are the two basic categories of health insurance plans?

Back 32

Indemnity

Managed care

Front 33

What are some factors affecting health care costs?

Back 33

-Americans are living longer

-Advances in medical technology

-Media intervention

Front 34

What is a comprehensive plan?

Back 34

Combination of both basic and major medical coverage in one plan.

Front 35

Preexisting Conditions

Back 35

A physical or medical condition that existed prior to the issuance of health insurance.

Front 36

Basic Medical Coverage

Back 36

Pays for room and care while patient in hospitalized.

May also cover certain hospital services and supplies.

Pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some doctor visit.

Front 37

Major Medical Coverage

Back 37

Takes over where basic coverage leaves off.

Covers the cost of long and high-cost illnesses or injuries.

Front 38

What can Managed Care Organizations dictate?

Back 38

Tells which doctors they can see.

Monitor medications and treatments prescribed.

Assures enrollees that their costs will remain as low as possible.