Health Insurance Vocabulary Flashcards
Name the term that meets the following definition: groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated, high-quality care.
Accountable Care Organization (ACO)
Name the term that meets the following definition: the person that receives any of the benefits of the insurance coverage.
Beneficiary
Name the term that meets the following definition: the payment of a fee to a healthcare provider providing services to a number of people, such that the amount paid is determined by the number of total patients.
Capitulation
Name the term that meets the following definition: the amount a beneficiary must pay for medical care after they have met their deductible.
For instance, the insurance company may pay for 80% of an approved amount, and the patient’s __________ will be for 20%.
Coinsurance
Name the term that meets the following definition: the flat fee that a beneficiary must pay each time they receive medical care.
For example, a patient may pay a $10 ______ for every doctor visit, while the insurance plan covers the rest of the cost.
Copayment
Name the term that meets the following definition: the maximum amount that a health insurance plan may pay for certain healthcare services. Some health insurance policies may also have a maximum annual or lifetime coverage amount. After any of these limits are reached, then the policyholder may have to pay for all remaining costs.
Coverage limits
Name the term that meets the following definition: the amount the beneficiary must pay each year before their health insurance coverage plan begins paying.
Deductible
Name the term that meets the following definition: services that are not covered by the specific insurance plan. These must be clearly defined in the plan literature.
Exclusions / limitations
Name the term that meets the following definition: a payment system where healthcare services are unbundled and paid for separately.
Fee-for-service
Name the term that meets the following definition: an insurance provider’s list of covered drugs.
Formulary
Name the term that meets the following definition: a form of managed care in which all care is received from participating providers within the network. A referral from a primary care provider needs to be obtained prior to seeing specialists.
Health maintenance organization (HMO)
Name the term that meets the following definition: an account established by an employer to pay an employee’s medical expenses. Only the employer can contribute to a ___.
Health reimbursement account (HRA); HRA
Name the term that meets the following definition: an account established by an employer or an individual to save money toward medical expenses on a tax-free basis.
Health savings account (HSA)
Name the term that meets the following definition: a plan that provides comprehensive coverage for high-cost medical events but features a high deductible coupled with a limit on annual out-of-pocket expense.
High-deductible health plan (HDHP)
Name the term that meets the following definition: insurance coverage purchased independently (as opposed to as part of a group), usually directly from an insurance company.
Individual health insurance
Name the term that meets the following definition: a federal program administered by individual States to provide healthcare for certain poor and low-income individuals and families.
Medicaid
Name the term that meets the following definition: a federal insurance program that provides healthcare coverage to eligible individuals aged 65 and older and certain disabled people (such as those with end-stage renal disease).
Medicare
Name the term that meets the following definition: a group of physicians, hospitals, and other providers who participate in a particular managed care plan.
Network
Name the term that meets the following definition: the maximum amount that an insured person can pay, after which the insurance plan pays all further covered costs. Out-of-pocket maxima may be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Out-of-pocket maxima
Name the term that meets the following definition: a form of managed care in which insurance policyholders have more flexibility in choosing physicians and other providers than in an HMO. Both participating and nonparticipating providers may be seen, however the out-of-pocket expenses paid by the policyholder will vary.
Preferred provider organization (PPO)
Name the term that meets the following definition: the amount the insurance policyholder pays to belong to a health plan. In general under employer-sponsored health insurance, the employee’s share of premiums is usually deducted from their pay.
Premium
Define the following term:
Accountable Care Organization (ACO)
Name the term that meets the following definition: groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated, high-quality care.
Define the following term:
Beneficiary
The person that receives any of the benefits of insurance coverage.
Define the following term:
Capitulation
The payment of a fee to a healthcare provider providing services to a number of people, such that the amount paid is determined by the number of total patients.
Define the following term:
Coinsurance
The amount a beneficiary must pay for medical care after they have met their deductible. For instance, the insurance company may pay for 80% of an approved amount, and the patient’s coinsurance will be for 20%.
Define the following term:
Copayment
The flat fee that a beneficiary must pay each time they receive medical care. For example, a patient may pay a $10 copay for every doctor visit, while the insurance plan covers the rest of the cost.
Define the following term:
Coverage limits
The maximum amount that a health insurance plan may pay for certain healthcare services. Some health insurance policies may also have a maximum annual or lifetime coverage amount. After any of these limits are reached, then the policyholder may have to pay for all remaining costs.
Define the following term:
Deductible
The amount the beneficiary must pay each year before their health insurance coverage plan begins paying.
Define the following term:
Exclusions / limitations
Services that are not covered by the specific insurance plan. These must be clearly defined in the plan literature.
Define the following term:
Fee-for-service
A payment system where healthcare services are unbundled and paid for separately.
Define the following term:
Formulary
An insurance provider’s list of covered drugs.
Define the following term:
Health maintenance organization (HMO)
A form of managed care in which all care is received from participating providers within the network. A referral from a primary care provider needs to be obtained prior to seeing specialists.
Define the following term:
Health reimbursement account (HRA)
An account established by an employer to pay an employee’s medical expenses. Only the employer can contribute to an HRA.
Define the following term:
Health savings account (HSA)
An account established by an employer or an individual to save money toward medical expenses on a tax-free basis.
Define the following term:
High-deductible health plan (HDHP)
A plan that provides comprehensive coverage for high-cost medical events but features a high deductible coupled with a limit on annual out-of-pocket expense.
Define the following term:
Individual health insurance
Insurance coverage purchased independently (as opposed to as part of a group), usually directly from an insurance company.
Define the following term:
Medicaid
A federal program administered by individual States to provide healthcare for certain poor and low-income individuals and families.
Define the following term:
Medicare
A federal insurance program that provides healthcare coverage to eligible individuals aged 65 and older and certain disabled people (such as those with end-stage renal disease).
Define the following term:
Network
A group of physicians, hospitals, and other providers who participate in a particular managed care plan.
Define the following term:
Out-of-pocket maxima
The maximum amount that an insured person can pay, after which the insurance plan pays all further covered costs. Out-of-pocket maxima may be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Define the following term:
Preferred provider organization (PPO)
A form of managed care in which insurance policyholders have more flexibility in choosing physicians and other providers than in an HMO. Both participating and nonparticipating providers may be seen, however the out-of-pocket expenses paid by the policyholder will vary.
Define the following term:
Premium
The amount the insurance policyholder pays to belong to a health plan. In general under employer-sponsored health insurance, the employee’s share of premiums is usually deducted from their pay.
