CPCU 553 Ch. 11 Flashcards
A type of healthcare plan that allows patients to choose their own healthcare provider and reimburses the patient or provider as a certain percentage (usually after a deductible is paid) for services provided
Indemnity plan
Coverage for medical expenses, such as hospital and surgical expenses, physicians visits, and miscellaneous medical services
Basic medical expense coverage
Insurance that covers medical expenses resulting from illness or injury that are not covered by a basic medical expense plan
Major medical insurance
A type of healthcare plan that provides members with comprehensive services and encourages them to use providers belonging to the plan
Managed care plans
An organization that provides all the care needed by its members in exchange for a fixed fee
Health maintenance organization (HMO)
An administrative organization that meets the common needs of healthcare providers and clients that identify networks or providers and contracts for their medical services at discounted rates
Preferred provider organization (PPO)
Managed care plan that combines the characteristics of an HMO and a PPO; has a network of preferred providers who, if used by the members, charge little or nothing for services; healthcare received out of the network covered, but members must pay substantially higher coinsurance charges and a deductible
Point of service (POS) plan
Social insurance program that covers the medical expenses of most individuals age sixty five or older
Medicare
Health insurance plan options that provide benefits in addition to basic medicare; offered by private insurers that contract with medicare and available to beneficiaries currently enrolled in Medicare Part A and Part B
Medicare advantage plan
Medical insurance provision that requires the insured to pay part of that covered medical expenses in excess of the deductible Coinsurance
Coinsurance
Initial time period in a health insurance or disability income policy during which benefits are not paid
Eliminated period
