Health Insurance Flashcards
It refers to the variety of policies that can be purchased to cover certain health-related services and goods
Health Insurance
covered by the policy
Insurance
individual who purchases the policy
Subscriber
It s the process by which healthcare providers receive payment for their health care services
Reimbursement
A formal request for payment made by an insured individual to their policy provider; made after an incident
Insurance claim
-an amount to be paid periodically for an
insurance policy (contract)
Premium
A system of making and trading things of
value. It is usually divided into goods and services
Economy
- Health care providers are paid after health care services are rendered
Retrospective
Payment method wherein physicians and other
healthcare providers are paid separately for each
unbundled service
Free for Services
It refers to the various methods of paying
hospitals, health systems and organizations, or healthcare providers in which payments are established in advance
Prospective
It is the law that established the Philippine Health
Insurance Corporation (PhilHealth).
R.A 7875
Government-owned and controlled corporations established on
February 14, 1995
The primary goal of PhilHealth
To provide social health insurance for all
Filipino.
This is exemplified in PhilHealth as
members who are:
- healthy subsidize the sick;
- earning more subsidize those who earn less; and
- those who have no income are subsidized by the government
enrolled by their respective employers
Formal Economy
It applies for membership on their own
Informal Economy
Sponsors facilitate their enrollment
Sponsored Members
The Department of Social Welfare and Development (DSWD) is tasked by the national Government to facilitate enrollment
Indigents
Need to apply for membership to qualify under this category
Lifetime Membership and Senior citizens
PhilHealth benefits
- Hospital Benefit
- OUTPATIENT BENEFITS
It can be availed if confinement is not less than 24 hours in all PhilHealth-accredited hospitals
Hospital Benefit
- Day surgeries or minor surgical procedures
- Dialysis
- Chemotherapy
- Radiation Therapy
- Cataract Extraction
- Malaria Treatment
- TB treatment
- HIV Treatment
- Animal Bite Treatment
Out-patient benefits
Medicare, Medicaid, and the Federal Employee’s Health Benefits Plans represent the
government health plans.
GOVERNMENT HEALTH INSURANCE
Administered by the federal government - Center for Medicare and Medicaid services (CMS)–an
Medicare
