Health Insurance

Question 1

Copayment

Answer 1

A way of sharing medical costs
- you pay flat fee every time you receive a medieval service
Ex.)$20 for every visit to the doctor
- insurance pays the rest

Question 2

Deductible

Answer 2

The amount of money you must pay each year to cover your medical expenses
- before you hour insurance starts paying

Question 3

Exclusions

Answer 3

Specific conditions or circumstances for which the policy will not provide benefits

Question 4

Health maintenance organization (HMO)

Answer 4

Health insurance plan that allows you yo pay a monthly or quarterly premium in exchange for health care services

• HMO’s require you to work with primary care physician who will direct your care and refer you to specialists as needed
• they also require you to see doctors, hospitals, and labs within their network of providers

Question 5

Health savings account (hsa)

Answer 5

A health savings account

• is a type of medical savings account that allows you to save money
• to pay for current and future medical expenses on a tax- free basis
• in order to be eligible for a health savings account
• you must be covered by a high- deductible health plan ,

    - not have any other health insurance 
   - not be claimed  as a dependent  on another's tax return

Question 6

Indemnity plans

Answer 6

These plans allow you to use any doctor , hospital or specialist you to choose and submit a claim for insurance.
- for reimbursement covered medical expenses
Indemnity plans pay a size able percentage ( usually around 80%) of what they consider the “ usual and customary” charges and you have to cover the rest

Question 7

Coinsurance

Answer 7

This amount you required to pay for medical care in certain types of health plans after you have met your deductible

• ex.)if the insurance company’s pays 80% of clams,
  - you have to pay 20% Coinsurance payment

Question 8

Managed care

Answer 8

The way health are system manages it costs and the use of of its resources.
-all HMO’s and PPO and even some fee for service plans ,apply managed techniques

Question 9

Maxium out of pocket

Answer 9

The Maxium amount of money you will be required to pay each year deductibles, Coinsurance and copayments.
- It’s a stated dollar amount set by the insurance companies , in adittion to regular premiums.

Question 10

Point of service(POS) plan

Answer 10

A health insurance plan that combines elements of an HMO and PPO.

• You can use a primary care physician or self direct your care at the “point of service”.
• The cost for service depends on the route you take yo get them.

Question 11

Preexisting condition

Answer 11

A health problem that existed before the date your insurance coverage became effective

Question 12

Preferred provider organization (PPO)

Answer 12

A health insurance plan that allows you to see any doctor at any time.
In addition to monthly or quarterly premium
- A PPO typically requires you to make a copayment for each service you receive.
/ Copayment for in network doctors and services
are lower than
Than copayments for out of network doctors.

Question 13

Premium

Answer 13

The amount paid by your employer , in addition to copayments, Coinsurance , and deductibles,
- in exchange for insurance coverage

Question 14

Preventive Care

Answer 14

Services to keep patients healthy
- in order to lower bills in the long run
Ex.) vaccines, mammograms , check ups

Question 15

Primary care physician

Answer 15

• monitors health
• diagnosis and treats minor probs.
  Refers you to a specialist if another level of care is needed
• refered to as family physians or internist