Health Insurance Providers Flashcards
The payment given to a physician for each member of a health maintenance organization assigned to them is called?
Capitation
When the hmo is represented by a group of physicians who are salaried employees and work out of the HMO’s facility is known as?
Closed panel (staff model HMO)
HMO which is characteristic by a network of physicians who work out of their own facilities and participate in the HMO on a part time basis is known as?
Open panel
Hmos are know for stressing what?
Preventive care
PPO?
Preferred provider organization
What is a PPO?
A collection of health care providers who offer their services to certain groups at prearranged discount prices.
PPOs operate on what?
A free for service basis
Medicare program of 1966?
Provide hospital and medical expense insurance protection for 65 and older, any individual who suffers from chronic kidney disease or to those who have been receiving ssc disability benighted for 24months
Medicare part A?
(Hospital insurance) covers inpatient care in hospitals and covers care provides in a hospice and some care provided at home.. also covers drugs administers as part of inpatient treatment
Social security administration handles what?
Enrollment for Medicare program and provides information to the public
The centers for Medicare and Medicare services do what?
Handel all parts of the Medicare program except what social security admin does
Medicare part A will cover a maximum of what?
100days per benifit period in skilled nursing facility y
The lifetime maximum for inpatient psychiatric care under part A is?
190 days
Federal payroll and self employment taxes are what?
The primary source of financing part A
Medicare part B does what?
Provides medical insurance for required doctors and many services not covered by part A
Are Medicare part B premium payments fully deductible from income?
Yup
Initial enrollment period for Medicare part B ends when?
3 months after the 65th birthday month
Open enrollment period for part B is?
Jan 1- March 31
Difference between the physicians actual charges and medicares approved amount is called?
Excess charge
Person who suffers from kidney failure is covered for the first 30months under the group med plan, after that the persons primary coverage will be from Medicare
Yut
Eligibility for SSC disibility income?
Be fully insured, at least one quarter of coverage for each calandra year after turning 21
Maximum SSC disability benifit an insured may receive?
Equal to 100% of the insureds primary insurance amount (PIA)
Medicaid is what chapter in the ssc act?
XIX
What’s medicaids purpose?
Provide matching federal funds to states for their medical public pans to help needy persons regardless of age
Who is Medicaid financed by?
Federal and state governments
