Chapter 7 Flashcards
Period of time during which benefits are paid under policy
Enrollee
Premium
Waiting period
Benefit period
Benefit period
Person enrolled in health ins plan, an insured doesn’t include dependents of insured
Enrollee
Benefit period
Waitin period
Per existing conditions
Enrollee
Conditions insured has recd diagnosis for diagnosis advice care or treatment during specific time period prior to Capp for health coverage
Benefit period
Premium
Social security disability insured status
Pre existing conditions
Pre existing conditions
Money paid to ins company for ins coverage
Waiting period
Medicare
Premium
Premium
Fully insured or currently insured depending on number of coverage credits earned
Social security disability insured status
Medicare
Premium
Social security disability insured status
Period of time that must pass after a loss occurs before insurer start paying policy benefits
Waiting period
Trial period
Executive period
Waiting period
Federal medical expense ins program for ppl age 65 and older even if individual continues to work
Actual charge insurance
Supplemental ins
Disability ins
Medicare
Medicare
Available to anyone regardless of age entitled to social security disability income benefits for two years or has permanent kidney failure
Rehab services
Medicare
Group care
Medicare
If already receives social security disability benefits what would need to be done to qualify for Medicare part a once 65
Nothing
Apply for coverage through state
Apply for coverage through social security administration
Nothing
Financed through portion of payroll tax FICA
Part a
Part b
Part c
Part d
Part a hospital ins
Financed from monthly premiums paid by insureds and from general revenues of federal govt
Part a
Part b
Part c
Part d
Part b
Allows ppl to rec all of their health care services through available provider organizations
Part a
Part b
Part c
Part d
Part c
Is for prescription drug coverage
Part a
Part b
Part c
Part d
Part d
Does not require patient to choose primary care doc nor does it require referral to see specialist as long as specialist is enrolled in Medicare
Ambulatory surgical services
Medicare part d
Original Medicare
Original medicare
Amount physician actually bills for particular service or supply
Actual charge
Provided at ambulatory center/performed at center that doesnt require hospital stay unlike inpatient hospital surgery
Ambulatory surgical services
Amount Medicare determines to be reasonable for service that is covered under part b of Medicare
Assignment
Carriers
Actual charge
Approved amount
Approved amount
Physician or medical supplier agrees to accept Medicare approved amount as full payment for covered services
Assignment
Carriers
Excess charge
Assignment
Organizations that process claims that are submitted by doctors and suppliers under Medicare
Carriers
Xo insurance
Limiting charge
Carriers
Portion of Medicare’s approved amount that beneficiary is responsible for paying
Coinsurance
Deductible
Excess charge
Coinsurance
Outpatient services recd from Medicare participating comprehensive outpatient rehab facility
Peer review organization
Pap smear screening
Comprehensive outpatient rehabilitation facility services
Comprehensive outpatient rehabilitation facility services
Organizations that process inpatient and outpatient claims on individuals by hospitals skilled nursing facilities home health agencies hospices or other providers of health services
Limiting charge
Intermediaries
Excess charge
Intermediaries
Maximum physician may charge Medicare beneficiary
Limiting charge
Peer review organization
Participating doctor or supplier
Limiting charge
Program of outpatient mental health care
Peer review organization
Nonparticipating
Limiting charge
Partial hospitalization for mental health care
Partial hospitalization fo mental health care
Groups of practicing doctors and other health care professionals who are paid by govt to review care given to Medicare patients
Pap smear screening
Participating doctor or suppliers
Peer review organizations
Peer review organizations
Bill confined in skilled nursing facility. Medicare will pay full benefits in facility for how many days
100
80
3
20
20
Days 21 through 100 require a daily
Threshold
Advice
Physician’s note
Copayment
Copayment
Citizen or legal resident of US age 65 or over and qualified for social security or railroad retirement benefits
Entitled to monthly social security benefits based upon the spouse’s work record and the spouse is at least 62; younger than 65 but has been entitled to social security disability benefits for 24 months/disabled; has end stage renal disease/permanent kidney failure that requires dialysis or transplant/has als
Aleatory eligible
Dependent care eligible
Hsa eligible
Medicare part a eligible
Medicare part a eligible
Pays for inpatient care inpatient care in skilled nursing facility home health care and hospice care is known as
Part a
Part b
Part c
Part d
Part a
Not an enrollment period for Medicare part a applicants
Initial enrollment
Special enrollment
General enrollment
Automatic enrollment
Automatic enrollment
Three enrollment periods for Medicare part a
Initial general special
Beginning end middle
Moon sun ground
Initial general special
All of following qualify for Medicare part a except
Someone in renal failure
Someone with social security
Someone over 65 willing to pay premium
Anyone willing to pay premium
Anyone willing to pay premium
All following are covered by part a of Medicare except
Physician and surgeon services
Home health services
Post hospital nursing care
Physician and surgeon services
To rec benefits under Medicare part a for care in skilled nursing facility which must be met
Insured must cover daily copayments
Insured must have first been hospitalized for 3 consecutive days
Insured must have a Medicare suppplement ins policy
Insured must have first been hospitalized for 3 consecutive days
Fully insured under social security means they have earned
40 quarters of coverage equivalent of 10 years of work
