Chapter 2 Flashcards
Savings account similar to HSA but limited to qualified individuals based on income.
Health Savings Security Account
A healthcare organization characterized by a payment and care delivery model
that seeks to tie provider reimbursements to quality metrics
and reductions in the total cost of care for an assigned population of patients.
Accountable Care Organizations (ACO)
Fixed payment remitted at regular intervals to
a medical provider by a managed care organization for an
enrolled patient.
Capitation
A service not covered in a health insurance
contract, usually reimbursed according to a different arrangement or rate formula than those services specified under the
contract umbrella.
Carve-out
Third tier insurance
plans that give the members more control over their health
budgets.
Consumer Driven Health Plans (CDHP)
A specified dollar amount the policyholder must
pay to a healthcare provider for each visit or medical service
received. This is typically found on the insurance card.
Copay
A process that is used to evaluate the qualifications and practice history of a physician which includes a
review of a physician’s completed education, training, residency, and licenses.
Credentialing
Managed care plan in
which healthcare expenses are funded by insurance coverage;
the individual selects one of each type of provider to create a
customized insurance premium.
Customized Sub-Capitation (CSC)
A worldwide computerized database of all uniformed service members, their spouses and family members, and others who
are eligible for TRICARE.
DEERS (Defense Enrollment Eligibility Reporting System)
An annual specified dollar amount the policyholder must pay before the insurance carrier begins paying for
services.
Deductible
Insurance that protects an
employer from damages from a lawsuit resulting from an
injury due to the employer’s negligence.
Employers’ Liability Insurance
An organization
that has entered into contracts with medical care providers or
groups of medical care providers to provide healthcare services
to members.
Exclusive Provider Organization (EPO)
A tax-advantaged healthcare account an individual contributes money into that is used
to pay for certain out-of-pocket healthcare costs.
Flexible Spending Account (FSA)
A physician, typically a primary care physician,
like a family practitioner, internist, or pediatrician, who is
responsible for determining a patient’s primary services and
coordinating care so that the patient receives the appropriate
needed services.
Gatekeeper
Health plans that are purchased by
employers for its employees. A portion of the group health plan
premium may be paid by the employer.
Group Health Plans
