Chapter 13-Other Healthcare Providers Flashcards
nonprofit membership based service organization established primarily for the purpose of providing hospital and medical expense payments directly to the provider
Blue Cross Blue Shield
a prepaid service organization that provides both the protection against healthcare expenses as well as the healthcare providers themselves; they specialize in prevention and managed care
Health Maintenance Organization (HMO)
general practitioner responsible for the oversight of a members care
Primary Care Physician
the primary physician acts as a ____________ to limit access to more expensive services of specialists and higher cost services
Gatekeeper
a minimal fee charged to encourage a doctor visit to avoid insureds delaying medical treatment
Co Pay
a ________consists of physicians that are employed by an HMO
Network
HMOs changed from an _________ to a _________ to allow physicians to maintain their individual practice as well as represent the HMO
Closed Panel System to an Open Panel System
a traditional insurance plan covering health care expenses as a prearranged discount
Preferred Provider Organization (PPO)
an HMO that allows the member to leave the HMO for treatment outside of the network
Point of Service
all insurance companies must provide__________within the policies offered to individuals and small groups
Essential Health Benefits
health insurance requirement for an individual
Individual mandate
coverage defined by the federal government that an individual must maintain for themselves and their dependents or they will receive an IRS tax penalty
Minimum Essential Coverage (MEC)
health plans certified by the ACA to meet requirements and offered through the Marketplace
Qualified Health Plan (QHP)
provides assistance with premium payments on plans purchased through the Marketplace
Premium Tax Credit (subsidy)
for those who but through the Marketplace, choose a Silver Plan and earn less than 250% of the Federal Poverty Level
Cost-Sharing Reduction
