Health Insurance Basics Flashcards
main difference between traditional health insurance arrangements and HMOs
HMOs provide both the health care service and the health care financing, but traditional health care insurance companies provide only the financing
Blue Cross/Blue Shield is an example of…
a producers cooperative
an HMO that contracts with an independent medical group that specializes in a variety of medical services in order to provide those services to HMO subscribers…
a group model HMO
an HMOs contracting physicians are paid employees working on the staff of the HMO, operating a clinic setting at the HMOs physical facilities…
a staff model HMO
an HMO that contracts with medical group to increase accessibility to providers as a convenience for subscribers…
a network model HMO
an HMO that was started by a group of individual physicians, and each physician operates out of his own office. paid on fee-for-service basis with fess negotiated in advance…
an individual practice association model HMO
HMO definition
contracts with select doctors and hospitals to be a health care provider for its members. enrollees in the HMO receive services for a fixed premium paid in advance
small employer group health insurance requirement
few than 50 full-time employees. part-time and independent employees are not considered
examples of typical groups that contract with PPOs
employers, insurers, and health benefit providers
