CH 8 Flashcards
What are entitlement programs
government insurance
Employee Sponsored Medical Insurance
Group Health Plan (GHP)
Group Health Plan regulated by who?
State
Largest Employer Sponsored plan
Federal Employees Health Benefits (FEHB) Program
Law providing incentives and protection for companies with employees health and pension plans
Employee Retirement Income Security Act (ERISA)
Required document for self-funded plans
Summary Plan Description (SPD)
Self-funded health plans regulated by who?
Department of Labor
Business associate of health plan
Third Part Claims Administrator (TPA)
Waiting Period
time from being hired to being eligible for insurance
late enrollee
enrolled outside of open enrollment due to special circumstances
List of a plans approved drugs
formulary
tiered network
system that reimburses more for quality cost effective providers
COBRA Consolidated Omnibus Budget Reconciliation Act
allows terminated employees to pay for health coverage (for employers with more than 20 employees)
Equality with medical/surgical benefits
Parity
PPO Providers based on?
discounted fee for service
HMO and POS may be?
capitated or salary
Consumer Driven Health Plans (CDHP)
High Deductible and Savings Account
Health Savings Account only employer contributes
Health Reimbursement Account (HRA)
Either employer or employee can contribute
Health Savings Account (HSA)
Both employer and employee can contribute. Allows money to be used for a few other things such as childcare
Flexible Savings (Spending) Account (FSA)
credentialing
period verification of a prover or facility
BCBS
Blue Cross Blue Shield
BCBS Pay-for-Performance (P4P)
financial incentitives program based on provider performance
BlueCard
program that provides benefits for subscribers away from their local areas
