Module 1 Ecm Cards

Front 1

Fee For Service

Back 1

Definition: FFS plan pays health care providers for every service provided, and theoretically at the amount that they charge.
Pros: Control over health care decisions by physicians and patients.
Cons: This is the most inflationary form of health insurance. “More” may not result in better outcomes.

Front 2

Health Maintenance Organization

Back 2

Definition: A form of insurance that pays a capitated rate (provider gets the same amount no matter how much care is provided) to provide all of a patient’s care.
Pros: Flat monthly rate with no deductibles and extremely low co-pays for the insured. Usually cover prescription drugs and preventative care.
Cons: Only visits to professionals within the HMO network are covered. All visits, prescriptions and other care must be cleared by the HMO in order to be covered. A primary physician within the HMO handles referrals.

Front 3

Preferred Provider Organization

Back 3

Definition: A PPO pays a premium to an insurance company that contracts with private-practice doctors, labs, care facilities, and hospitals to provide care to the members of the insurance plan.
Pros: Less expensive than FFS because providers agree to rates; somewhat less patient freedom in choices than FFS, but more freedom than HMO.
Cons: More expensive than HMO; does not solve the “pay by the service” problem.

Front 4

High Deductible Health Plan with Health Savings Account

Back 4

Definition: A form of insurance characterized by low premiums and high deductibles.
Pros: The insured person chooses when and where to obtain care. Access to tax advantaged health savings accounts.
Cons: Insured person is exposed to a high degree of annual risk through the deductible. Must pay for services until deductible is met (e.g. if you get sick, you have to pay the doctor the full amount).