Health Insurance

Question 1

deductible

Answer 1

money paid by patient before insurance patients “kick in” - some services may be exempt such as yearly physicals

Question 2

co-pay or co-insurance

Answer 2

expenses shared by patient and insurance company, usually for office visits and pharmaceuticals

Question 3

group insurance

Answer 3

premiums are paid at least partially by the employer

Question 4

HMO (health maintenance organization)

Answer 4

type of insurance plan, emphasize preventative care, early treatment, exams and screening, vision care, theory that prevention reduces long-term costs, limited options for providers and facilities (only those in the plan)

Question 5

PPO (preferred provider organization)

Answer 5

supplied by large companies or industries, more popular than HMOs, contract with providers for certain services at reduced rates (giving consumers more options for physicians and facilities)

Question 6

EPO (exclusive provider organization)

Answer 6

least popular, charges fee to access network of providers, contracts with providers at reduced cost, no choice in provider (assigned), do not own physicians or clinics, no out-of-network coverage

Question 7

Medicare: Title 18

Answer 7

amendment to Constitution, entitlement program, hospital care of 65 and older OR those who have a disability and have received Social Security for 2+ years, pays all costs associated with end-stage renal failure (for any patient), Type A (hospital only), Type B (office visits and procedures, purchased), Type C (B purchased privately), Type D (drug coverage, purchased)

Question 8

worker’s compensation

Answer 8

for treatment of job-acquired injuries, administered by state, payments made by employer and state, also pays for lost wages

Question 9

managed care

Answer 9

to reduce rising healthcare costs, belief that all healthcare should have a purpose, second opinion or verification required, HMOs and PPOs, some private insurance companies, consumer is restricted in choice of healthcare

Question 10

government

Answer 10

Tricare for veterans / active duty members / families, type of managed healthcare program

Question 11

Medicaid

Answer 11

government insurance for those who qualify because they can’t afford regular insurance

Question 12

health savings account (HSA)

Answer 12

a type of medical savings account that allows patient to save money to pay for current and future medical expenses

Question 13

indemnity plans

Answer 13

allow patient to use any doctor / hospital / specialist as long as they submit a claim to the insurance company for reimbursement

Question 14

point of service plan (POS)

Answer 14

combines elements of HMO and PPO

Question 15

premium

Answer 15

amount paid in addition to copayments / coinsurance / deductibles

Question 16

preventative care

Answer 16

services designed to keep patients healthy before major issues arise