Chapter 9: Insuring Your Health Flashcards
Health insurance costs are rising.
true
Health insurance plans are separated into 2 categories. What are they?
- private plans
- government plans
What are the 2 types of private health insurance plans?
- indemnity (fee-for-service) plans
- managed care plans
a contract between a group and a healthcare provider.
group health insurance
a health insurance plan where the healthcare provider is separate from the insurer and the plan pays 80% of medical expenses and the insured pays the other 20%.
traditional indemnity (fee-for-service) plans
the amount that an insurance company pays on a traditional indemnity plan is based on the…
usual, customary, reasonable (UCR) charges.
health insurance plan where users contract with and make monthly payments directly to the organization that provides health care services.
managed care plans
under managed care plans, the insured only pays a co-payment for office visits and medication.
true
- health maintenance organization (HMO)
- preferred provider organization (PPO)
- exclusive provider organization (EPO)
- point-of-service (POS) plan
These are types of what kind of private health insurance plan?
managed care plans
managed care plan that consists of an organization of hospitals, physicians, and other healthcare providers that provide comprehensive health care services to its members.
health maintenance organization (HMO)
what are the 2 types of HMOs?
- group HMO
- individual practice association (IPA)
type of managed care plan where insurance company contracts w/ a network of physicians and hospitals that agree to accept negotiated fee for services.
preferred provider organization (PPO)
type of managed care plan that contracts w/ medical providers to offer services to members at reduced costs, but reimburses members only when affiliated providers are used.
exclusive provider organization (EPO)
type of managed care plan that is a hybrid form of HMO that allows members to go outside of the HMO network for care.
point-of-service (POS) plan
type of managed care plan that consists of prepaid hospital and medical expense plans.
Blue Cross/Blue Shield Plans
what are the 3 types of government health care plans?
- medicare
- medicaid
- workers’ compensation insurance
Pre-existing Condition Insurance Plans (PCIPs) provided health coverage to U.S. citizens who had been denied health insurance coverage because of a pre-existing condition prior to what act?
Affordable Care Act
type of government health insurance plan that is administered by the social security administration for those over 65 or who are disabled.
medicare
medicare provides:
1. basic hospital insurance (Part A)
2. supplementary medical insurance (SMI) program (Part B)
3. medicare advantage plans (Plan C)
4. prescription drug coverage (Part D)
true
government health insurance plan that is state-run public form of assistance program providing health insurance benefits to those who are unable to pay for health care.
medicaid