Ch 12: Health Insurance Providers Flashcards

1
Q

Under which health plans are insured required to file a settlement claim form?

A

Indemnity plans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The basic factor of an indemnity plan is that the participants select a PCP and submit claims to?

A

The insurance company

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Service providers, such as, HMO, PPO’s, the payments are made directly to?

A

The doctor/hospital.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

HMO contains costs by promoting?

A

Preventative care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

An HMO does not emphasize in the use of?

A

Specialty physicians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’s capitation fee?

A

When an HMO pays the physical Ian a flat monthly fee for every member, regardless of the actual services provided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s open panel?

A

Service at own office, open to both members and non members of HMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s closed panel?

A

Services only HMO members, service at HMO service office

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is staff model?

A

When the HMO owns the hospital and doctors are employees of the HMO.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fluoride treatments are/are not a basic service

A

Are not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

An HMO does/does not have to provide subscription drugs

A

Does not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s a PPO?

A

The health care providers are paid on a fee for service basis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What’s an EPO?

A

It’s a type of PPO that uses the gatekeeper system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What self insurance ?

A

Company will provide money to cover costs of their employee medical bills. They would usually use TPAs (third party admin$

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

On an HSA, is an insured withdrew for non medical

Purposes. They are taxed how much?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is medical?

A

Jointly financed by the fed and state program for low income people