Block 2 Flashcards
Premium
The amount the patient pays for the insurance policy to the insurance company
May be paid paritally by the patient and partially by the employer
Deductible
The amount the patient pays prior to the the insurance company paying anything
Highly Variable
cost sharing concept
Co-Insurance
The amount in percentage that the patient pays and the insurance company pays upon the submittal of a claim
cost sharing concept
Co-Payment
A single amount the patient pays out of pocket
cost sharing concept
Annual/Yearly Out of Pocket Max/Limit
The amount that the patient is responsible for paying over the course of the year and anything over the amount is paid for in full by the insurance company
Annual Benefit Maximum
The max amount the insurance company will pay in a year often paired with a lifetime benefit max
Lifetime Benefit Maximum
The isurance company will no longer pay after an amount is met
Chargemaster
A list of items that the healthcare provider charges for, $ amount next to code determined by billing department
ex: CPT codes, by 15 mins
HMO- Health Maintenance Organization
a plan that usually limits coverage to care from providers who work for or contract with the HMO
Generally doesn’t cover out of network providers
PPO - Preferred Provider Organization
a plan that contracts with medical providers (hospitals & doctors) to create a network of participating providers where care is cheaper
Out of network providers are available at a higher cost
HSA - Health Savings Account
A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses like deductibles, co-payments, co-insurance
Can only contribute to an HSA with an eligible plan
