Ch 12: Health Insurance Providers Flashcards
Under which health plans are insured required to file a settlement claim form?
Indemnity plans
The basic factor of an indemnity plan is that the participants select a PCP and submit claims to?
The insurance company
Service providers, such as, HMO, PPO’s, the payments are made directly to?
The doctor/hospital.
HMO contains costs by promoting?
Preventative care
An HMO does not emphasize in the use of?
Specialty physicians
What’s capitation fee?
When an HMO pays the physical Ian a flat monthly fee for every member, regardless of the actual services provided.
What’s open panel?
Service at own office, open to both members and non members of HMO
What’s closed panel?
Services only HMO members, service at HMO service office
What is staff model?
When the HMO owns the hospital and doctors are employees of the HMO.
Fluoride treatments are/are not a basic service
Are not
An HMO does/does not have to provide subscription drugs
Does not
What’s a PPO?
The health care providers are paid on a fee for service basis
What’s an EPO?
It’s a type of PPO that uses the gatekeeper system.
What self insurance ?
Company will provide money to cover costs of their employee medical bills. They would usually use TPAs (third party admin$
On an HSA, is an insured withdrew for non medical
Purposes. They are taxed how much?
20%
