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14 Cards in this Set

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HMO

Health Maintenance Organization

What is HMO (Health Maintenance Organization)?

- Choose 1 Primary Care Provider (PCP), they refer to specialist


- All your care if coordinated through that PCP

PPO

Preferred Provider Organization

What is PPO (Preferred Provider Organization)?

- Insurance company allows you to hoist from particular MD's


*Tell - Decide PCP


*Choose Specialist

What is Medicare?

Health insurance for 65 and older + disabled (diseases such as Alzheimer's).

What is Medicaid?

Health insurance for lower income families.

What is a premium?

What you pay monthly for health insurance.

What is a deductible?

What you have to pay before insurance will start to cover it.

What is a copay?

Set dollar amount for a particular service.

What is coinsurance?

When the health insurance company pays a percentage of your medical bill after you pay your deductible.

What is OOP?

Means Out of Pocket. Money amount before insurance pays.

What is OOP Max?

Max amount of money paid before insurance covers 100%.

Name the main rights listed in the Affordable Care Act - 2010 Universal Healthcare?

1. Everyone must have healthcare or pay fines.


2. Ages 26 and younger may stay on parents insurance.


3. No denial of pre-existing conditions.


4. Small businesses must provide coverage to >12 employees.

BCBS Gold


Deductible: $5,000


ED: 50%


PCP: $10


Specialist: $100


Prescription: 80%


Premium: $275


How much does this patient owe before HI benefits are paying on a bill?


One this patient has met their deductible, they owe $1,275, how much do they pay?

1. $5,000


2. $637.50