Health Insurance

Question 1

It refers to the variety of policies that can be purchased to cover certain health-related services and goods

Answer 1

Health Insurance

Question 2

covered by the policy

Answer 2

Insurance

Question 3

individual who purchases the policy

Answer 3

Subscriber

Question 4

It s the process by which healthcare providers receive payment for their health care services

Answer 4

Reimbursement

Question 5

A formal request for payment made by an insured individual to their policy provider; made after an incident

Answer 5

Insurance claim

Question 6

-an amount to be paid periodically for an
insurance policy (contract)

Answer 6

Premium

Question 7

A system of making and trading things of
value. It is usually divided into goods and services

Answer 7

Economy

Question 8

1. Health care providers are paid after health care services are rendered

Answer 8

Retrospective

Question 9

Payment method wherein physicians and other
healthcare providers are paid separately for each
unbundled service

Answer 9

Free for Services

Question 10

It refers to the various methods of paying
hospitals, health systems and organizations, or healthcare providers in which payments are established in advance

Answer 10

Prospective

Question 11

It is the law that established the Philippine Health
Insurance Corporation (PhilHealth).

Answer 11

R.A 7875

Question 12

Government-owned and controlled corporations established on

Answer 12

February 14, 1995

Question 13

The primary goal of PhilHealth

Answer 13

To provide social health insurance for all
Filipino.

Question 14

This is exemplified in PhilHealth as
members who are:

Answer 14

• healthy subsidize the sick;
• earning more subsidize those who earn less; and
• those who have no income are subsidized by the government

Question 15

enrolled by their respective employers

Answer 15

Formal Economy

Question 16

It applies for membership on their own

Answer 16

Informal Economy

Question 17

Sponsors facilitate their enrollment

Answer 17

Sponsored Members

Question 18

The Department of Social Welfare and Development (DSWD) is tasked by the national Government to facilitate enrollment

Answer 18

Indigents

Question 19

Need to apply for membership to qualify under this category

Answer 19

Lifetime Membership and Senior citizens

Question 20

PhilHealth benefits

Answer 20

1. Hospital Benefit
2. OUTPATIENT BENEFITS

Question 21

It can be availed if confinement is not less than 24 hours in all PhilHealth-accredited hospitals

Answer 21

Hospital Benefit

Question 22

1. Day surgeries or minor surgical procedures
2. Dialysis
3. Chemotherapy
4. Radiation Therapy
5. Cataract Extraction
6. Malaria Treatment
7. TB treatment
8. HIV Treatment
9. Animal Bite Treatment

Answer 22

Out-patient benefits

Question 23

Medicare, Medicaid, and the Federal Employee’s Health Benefits Plans represent the
government health plans.

Answer 23

GOVERNMENT HEALTH INSURANCE

Question 24

Administered by the federal government - Center for Medicare and Medicaid services (CMS)–an

Answer 24

Medicare

Question 25

amount of money that a person or a business pays in exchange for the coverage offered by an insurance policy that fails to pay your premium when
it’s due will result in the cancellation of your policy

Answer 25

Premium

Question 26

• a set amount that you must pay each year (in addition to your premium) towards
  a loss or liability before your insurance company will start paying on your behalf

Answer 26

Deductible

Question 27

The percentage of costs of a covered health care service you pay(20%, for
example) after you’ve paid your deductible

Answer 27

Coinsurance

Question 28

a. Hospital insurance, covering: