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16 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Advance Beneficiary Notice |
Required by Medicare when a service is provided to a beneficiary that is either not covered or the provider is unsure of coverage |
ABN |
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Beneficiary |
Person entitled to benefits of an insurance policy |
This term is most widely used by Medicare |
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Birthday Rule |
The person whose birthday occurs first in the year is primary and the other is secondary |
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Carrier |
Term used to refer to insurance companies that reimburse for health care services |
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Coinsurance |
The percentage owed by the patient for services rendered after a deductible has been met and co-payment has been paid |
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Co-payment |
A specified amount the insured must pay toward the charge for professional services rendered at the time of service |
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Deductible |
A predetermined amount the insured must pay each year for before the insurance company will pay for an accident or illness |
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Explanation of Benefits |
A printed description of the benefits provided by the insurer to the beneficiary |
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Health Maintinance Organization |
Group insurance that entitles members to services by participating hospitals, clinics, and providers |
HMO |
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Health Savings Account |
Is a tax-sheltered savings account that can be used to pay for medical expenses |
HSA- like an IRA but for healthcare |
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Medicare |
A federal program for providing health care coverage for individuals over the age of 65 or those who are disabled |
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Preauthorization |
Relates not only to whether the services are covered but also whether the personal treatment is medically necessary |
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Preferred Provider Organization |
A network of providers and hospitals that are joined together to contract with insurance companies, employers, or other organizations to provide health care to their subscribers and their families for a discounted fee |
PPO |
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Primary |
Responsible for payment first |
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Secondary |
Responsible for payment after primary coverage |
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Subscriber |
The person who has been insured; an insurance policyholder |
Insurance policyholder |
